BlueCross BlueShield of Tennessee Medical Policy Manual

Transcutaneous Electrical Nerve Stimulation (TENS)

Does not apply to BlueCare.

DESCRIPTION

Transcutaneous electrical nerve stimulation (TENS) is an electronic stimulus generator that transmits electrical impulses of various configurations to electrodes on the skin for the purpose of pain management. TENS units, which are usually battery operated, have been used to relieve chronic intractable pain, post-surgical pain and pain associated with active or post-traumatic injury unresponsive to other standard pain therapies. The electrode is placed in an area that is closest to the site of pain. The mechanism of action is unknown, but it is purported that the electrical pulses block the transmission of pain to nerve fibers or may stimulate the release of endorphins or serotonin

Electrical Nerve Block, a form of TENS, is the use of transdermally applied electricity to obtain sympathetic neuron blockade in individuals experiencing regional chronic pain. The key difference between electrical nerve block and TENS is the electrode size, shape, configuration, placement, and time used to achieve sympathetic neuron blockade.

POLICY

See also:

MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

Does not apply to BlueCare.

ADDITIONAL INFORMATION

Scientific evidence is inadequate to validate the application of transcutaneous electrical nerve stimulation or provide comparisons to other treatments for conditions other than those listed as medically necessary.

SOURCES

American Academy of Neurology. (2010). Assessment: Efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders. Retrieved November 2, 2012 from http://www.neurology.org/content/early/2009/12/30/WNL.0b013e3181c918fc.full.pdf+html.

American Society of Anesthesiologists. (2010). Practice guidelines for chronic pain management: An updated report by the American Society of Anesthesiologists Task Force on chronic pain management and the American Society of Regional Anesthesia and Pain Medicine. Retrieved November 2, 2012 from http://journals.lww.com/anesthesiology/Fulltext/2010/04000/Practice_Guidelines_for_Chronic_Pain_Management_.13.aspx.

BlueCross BlueShield Association, Medical Policy Reference Manual. (7:2012). Temporomandibular joint dysfunction (2.01.21). Retrieved November 2, 2012 from BlueWeb. (19 articles and/or guidelines reviewed)

BlueCross BlueShield of Tennessee network physicians. 2002.

Complete Guide to Medicare Issues. [Computer software]. (2013, April). Supplies used in the delivery of transcutaneous electrical nerve stimulators (TENS) and neuromuscular electrical stimulation (NMES). (NCD 160.13, 2 - 80). OptumInsight, Inc.

U. S. Department of Health & Human Services. Centers for Medicare & Medicaid services. National Coverage Analyses (April, 2012). NCD for transcutaneous electrical nerve stimulators (TENS) (280.13). Retrieved November 2, 2012 from http://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=273&ncdver=1&CoverageSelection=Both&ArticleType=All&PolicyType=Final&s=Tennessee&KeyWord=TENS&KeyWordLookUp=Title&KeyWordSearchType=And&from2=search.asp&bc=gAAAABAAAAAA&.

U. S. Department of Health & Human Services. Centers for Medicare & Medicaid services. National Coverage Analyses (April, 2012). NCD for transcutaneous electrical nerve stimulators (TENS) for acute post-operative pain (10.2). Retrieved November 2, 2012 from http://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=145&ncdver=1&CoverageSelection=Both&ArticleType=All&PolicyType=Final&s=Tennessee&KeyWord=TENS&KeyWordLookUp=Title&KeyWordSearchType=And&from2=search.asp&bc=gAAAABAAAAAA&.

U. S. Department of Health & Human Services. Centers for Medicare & Medicaid services. National Coverage Analyses (June, 2012). NCD for transcutaneous electrical nerve stimulators (TENS) for chronic low back pain (160.27). Retrieved November 2, 2012 from http://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=354&ncdver=1&CoverageSelection=Both&ArticleType=All&PolicyType=Final&s=Tennessee&KeyWord=TENS&KeyWordLookUp=Title&KeyWordSearchType=And&from2=search.asp&bc=gAAAABAAAAAA&.

U. S. Food and Drug Administration. (2005, September). Center for Devices and Radiological Health. 510(k) Summary, K050435. Retrieved December 22, 2006 from http://www.fda.gov/cdrh/pdf5/K050435.pdf.

U. S. Food and Drug Administration. (2009, December). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K090889. Retrieved September 6, 2013 from http://www.accessdata.fda.gov/cdrh_docs/pdf9/K090889.pdf.

Winifred S. Hayes, Inc. Medical Technology Directory. (2010, April). Transcutaneous electrical nerve stimulation for postoperative and procedural pain. Retrieved October 3, 2012 from www.Hayesinc.com/subscribers. (63 articles and/or guidelines reviewed)

Winifred S. Hayes, Inc. Medical Technology Directory. (2010, July). Transcutaneous electrical nerve stimulation for acute pain. Retrieved October 5, 2012 from www.Hayesinc.com/subscribers.  (62 articles and/or guidelines reviewed)

ORIGINAL EFFECTIVE DATE:  7/1982

MOST RECENT REVIEW DATE:  3/14/2014   

ID_BT

Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

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