Transcutaneous Electrical Nerve Stimulation (TENS)
Does not apply to BlueCare.
Transcutaneous electrical nerve stimulation (TENS) describes the application of electrical stimulation to the surface of the skin at the site of pain. TENS has been investigated to treat chronic intractable pain, postsurgical pain, and pain associated with active or post-trauma injury unresponsive to other standard pain therapies. It has been proposed that TENS may provide pain relief through the release of endorphins in addition to potential blockade of local pain pathways. TENS may be applied in a variety of settings (home, physician’s office or outpatient clinic).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.
Transcutaneous electrical nerve stimulation (TENS) is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
Transcutaneous electrical nerve stimulation (TENS), for the treatment of other conditions/diseases, including, but not limited to, the following is considered investigational:
Temporomandibular Joint Dysfunction (TMJ)
Unstable angina pectoris
Prevention of migraine
Treatment of dementia
Pain during labor and delivery
Any device utilized for this procedure must have FDA approval specific to the indication, otherwise it will be considered investigational.
Transcutaneous electrical nerve stimulation (TENS) is considered medically appropriate if ALL of the following criteria are met:
For the management of ANY ONE of the following conditions:
Chronic intractable pain (e.g., musculoskeletal, neuropathic, cancer pain)
Acute postoperative pain
Documentation of ANY ONE of the following:
Initial request as a one-month trial period to permit the physician to study the effects and benefits
Efficacy and compliance have been demonstrated after an initial therapeutic trial
Treatment is administered using ANY ONE of the following applications:
Form-fitting conductive TENS garment if ANY ONE of the following are met:
Size of area is not feasible for conventional TENS
Frequency of stimulation required is not feasible for conventional TENS
Sites to be stimulated are inaccessible using conventional TENS
Documented medical condition (e.g., skin problem) precludes the application of conventional TENS
Individual has ANY ONE of the following:
Uncontrolled pain due to diminished effectiveness of medications
Uncontrolled pain due to medication side effects
History of substance abuse
Significant postoperative pain limits the ability to perform exercise programs/physical therapy treatment
Pain unresponsive to conservative measures (e.g., repositioning, heat/ice, etc.)
Absence of ALL of the following:
Inability to understand how to use the TENS unit for pain control
Implanted device such as pacemaker or defibrillator
Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g. statement.
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
Does not apply to BlueCare.
Overall, evidence for the use of transcutaneous electrical nerve stimulation (TENS) from high-quality trials remains inconclusive for most indications. The available studies are inconsistent on whether TENS improves outcomes, and the overall strength of the evidence is weak for all indications. The best evidence exists for treatment of chronic, intractable pain, and there is strong clinical support for this indication.
American Academy of Neurology. (January, 2010; reaffirmed January, 2018). Assessment: efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review). Retrieved April 26, 2019 from https://www.aan.com/Guidelines/home/GuidelineDetail/382.
BlueCross BlueShield Association. Evidence Positioning System. (11:2018). Transcutaneous electrical nerve stimulation (1.01.09). Retrieved April 26, 2019 from https://www.evidencepositioningsytem.com/. (83 articles and/or guidelines reviewed)
BlueCross BlueShield Association. Evidence Positioning System. (3:2019). Temporomandibular joint disorder (2.01.21). Retrieved April 26, 2019 from https://www.evidencepositioningsystem.com/. (36 articles and/or guidelines reviewed)
BlueCross BlueShield of Tennessee network physicians. 2002.
Centers for Medicare & Medicaid Services. (2012). CMS.gov. NCD for Transcutaneous Electrical Nerve Stimulation (TENS) for chronic low back pain (CLBP) (160.27).) Retrieved May 23, 2017 from https://www.cms.gov.
Centers for Medicare & Medicaid Services. (2013). CMS.gov. NCD for Transcutaneous Electrical Nerve Stimulation (TENS) for acute post-operative pain (10.2). Retrieved May 24, 2018 from https://www.cms.gov.
Chen, L., Zhou, Z., Li, Y., Ning, G., Li, Y., Wang, X., & Feng, S. (2016). Transcutaneous electrical nerve stimulation in patients with knee osteoarthritis: evidence from randomized-controlled trials. Clinical Journal of Pain, 32 (2), 146-154. Abstract retrieved May 24, 2017 from PubMed database.
Gross, T., Schneider, M., Bachmann, L., Blok, B., Groen, J., Hoen, L., et al. (2016). Transcutaneous electrical nerve stimulation for treating neurogenic lower urinary tract dysfunction: a systematic review. European Urology, 69 (6), 1102-1111. Abstract retrieved May 24, 2017 from PubMed database.
Jauregui, J., Cherian, J., Gwam, C., Chughtai, M., Mistry, J., Elmallah, R., et al. (2016). A meta-analysis of transcutaneous electrical nerve stimulation for chronic low back pain. Surgical Technology International, 28, 296-302. Abstract retrieved May 24, 2017 from PubMed database.
Kerai, S., Saxena, K., Taneja, B., & Sehrawat, L. (2014). Role of transcutaneous electrical nerve stimulation in post-operative analgesia. Indian Journal of Anaesthesia, 58 (4), 388-393. (Level 2 evidence)
National Comprehensive Cancer Network. (2019, March). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Adult cancer pain, version 2.2019. Retrieved April 26, 2019 from the National Comprehensive Cancer Network.
National Institute for Health and Care Excellence. (2011). Stable angina: management. Retrieved May 23, 2017 from www.nice.org.uk/guidance/cg126.
National Institute for Health and Care Excellence. (2014). Intrapartum care for healthy women and babies. Retrieved April 29, 2019 from www.nice.org.uk/guidance/cg190.
National Institute for Health and Care Excellence. (2014). Osteoarthritis: care and management. Retrieved May 23, 2017 from www.nice.org.uk/guidance/cg177.
National Institute for Health and Care Excellence. (2016). Low back pain and sciatica in over 16s: assessment and management. Retrieved May 23, 2017 from www.nice.org.uk/guidance/ng59.
Salazar, A., Stein, C., Marchese, R., Plentez, R., & Pagnussat, A. (2017). Electric stimulation for pain relief in patients with fibromyalgia: a systematic review and meta-analysis of randomized controlled trials. Pain Physician, 20, 15-25. (Level 1 evidence)
Wu, Y., Tsai, W., Tu, Y., & Yu, T. (2017). Comparative effectiveness of non-operative treatments for chronic calcific tendinitis of the shoulder: a systematic review and network meta-analysis of randomized-controlled trials. Archives of Physical Medicine and Rehabilitation, 2017 Apr 8. Pii: S0003-9993(17)30226-5. [Epub ahead of print]. Abstract retrieved May 24, 2017 from PubMed database.
ORIGINAL EFFECTIVE DATE: 7/1982
MOST RECENT REVIEW DATE: 5/9/2019
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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