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Date Printed: August 18, 2017: 08:00 PM

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Subject: Transcutaneous Electric Nerve Stimulation (TENS)

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This medical coverage guideline is not an authorization, certification, explanation of benefits, or a guarantee of payment, nor does it substitute for or constitute medical advice. All medical decisions are solely the responsibility of the patient and physician. Benefits are determined by the group contract, member benefit booklet, and/or individual subscriber certificate in effect at the time services were rendered. This medical coverage guideline applies to all lines of business unless otherwise noted in the program exceptions section.

 

DESCRIPTION

Transcutaneous Electric Nerve Stimulation, or TENS, is used to help manage pain. The TENS device has two or more electrodes, connected by wires. These electrodes attach to the skin at the site of the pain. The device then pulses an electric current to stimulate the nerves at the site. TENS devices may also be integrated into a garment. This is used to treat larger areas or multiple sites.

The BioniCare Bio-1000™ stimulator is approved by the U.S. Food and Drug Administration to treat arthritis of the knee and hand. This electronic stimulator is similar to a TENS device. It has leads that are placed over the affected area. The leads are held in place with a flexible wrap and Velcro.

Interferential Stimulation, or IFS, is another type electrical stimulation similar to TENS. Rather than providing constant current, IFS sends alternating high- and medium-frequency currents to the site of the pain.

Visit the Clinical View of this guideline for more information.

Visit WebMD for more information on Transcutaneous Electric Nerve Stimulation (TENS).

COVERAGE

 

Note: For all medical decisions about this service, Florida Blue uses the Position Statement in the Clinical View of this medical coverage guideline. To make the best decision for your health needs, talk to your doctor. The services covered vary from health plan to health plan. Refer to your health plan contract for complete information about your coverage.

 

Transcutaneous electrical nerve stimulator (TENS)

TENS may be considered medically necessary when used to treat:

• Acute pain after surgery

• Chronic, intractable pain where other treatments have failed.

TENS is considered experimental or investigational for the following:

• Pain relief for labor and vaginal delivery

• Managing nausea and vomiting of pregnancy

• Managing nausea and vomiting from surgery or chemotherapy

• Abdominal pain

• Pelvic pain

• Acute and chronic headache

• Osteoarthritis

• Rheumatoid arthritis

Clinical evidence is not sufficient to support using TENS for these conditions.

Conductive Garments

If FDA approved and prescribed by your doctor, a conductive garment may meet the definition of a medical need for:

• a large area or multiple sites that need stimulation so often that conventional electrodes will not manage the pain.

• chronic pain located in areas that can’t be treated with conventional electrodes.

• a medical condition, such as a skin condition, that prevents using conventional electrodes.

• electrical stimulation under a cast.

• rehabilitation strengthening after an injury where the nerve supply to the muscle is still intact.

Interferential stimulation (IFS)

IFS is considered experimental or investigational for treating pain. Scientific evidence is not sufficient to determine if IFS is effective.

PROGRAM EXCEPTIONS

• Federal Employee Program (FEP): Certain exceptions apply.

• State Account Organization (SAO): Certain exceptions apply.

• Medicare Advantage products: Certain exceptions apply.

Visit the Clinical View of this guideline for more coverage information.

Refer to your health plan contract for complete information about your coverage.

Date Printed: August 18, 2017: 08:00 PM