Insurance companies are finally recognizing the value of electrical nerve stimulation and it’s efficacy for pain management. Health Insurance will begin covering TENS units under many of their plans, including Medicare.
Health Insurance will begin covering TENS units and have finally started to admit that alleviating pain through the use of electrical nerve stimulation with TENS units has many medical benefits for their clients. Under new guidelines, Medicare will now be paying for TENS units for some patients (read below to learn more about the requirements for qualifying). It has taken many years for insurance companies to understand that pain management is a very important part of healthcare, so in many ways this is an important validation to the efficacy of electrical nerve stimulation for pain relief therapy.
It is well known that many people in the United States suffer from chronic lower back pain. Medicare’s decision to cover TENS units and related supplies used for chronic lower back pain, however, is predicated on participation in an approved clinical trial program. There is also an extensive list of what the approved diagnoses for lower back pain can be in order to qualify for the TENS unit. As part of this coverage, Medicare will specifically be covering the cost of TENS units for patients who are enrolled in these clinical studies and suffer from chronic lower back pain, as well as instances where the patient has chronic intractable pain that is not lower back pain, and for cases of acute post-operative pain.
According to Gordon Kelley with Medicare, “to qualify to receive a TENS unit when you have chronic intractable pain, the pain must be present for at least three months and you must have tried several other appropriate medical treatments. These treatments must have been ineffective and the pain that you are suffering must be a type that is accepted as being responsive to the TENS therapy.” There are certain restrictions with this program. Users must be monitored by their doctor and every two months they will be reevaluated. At the end of the two months they may bill for the purchase of the TENS units if the physician has determined that the user is likely to benefit from continued use.
Medicare Part B and Medicare Part C plans cover rental, and in some cases purchase, of a TENS device prescribed by a physician, but only under limited circumstances. The coverage rules differ depending on whether the patient is suffering acute postoperative pain or chronic pain.
- Acute post-operative pain. Medicare Part B covers the rental, for up to 30 days, of a TENS device for a patient in acute pain immediately following a surgical procedure. Coverage can be extended for rental beyond the initial 30 days in exceptional circumstances, as documented by the physician.
- Chronic pain. Medicare Part B may cover a TENS unit for a patient who has been suffering from chronic pain for at least three months, for which other, standard pain relief methods have failed. The pain must be of the type that typically responds to TENS; this does not include headache, internal abdominal pain, or temporomandibular (TMJ) pain in the jaw or face.
A qualifying chronic pain patient initially rents a TENS device for 30 to 60 days, after which the treating physician must certify that the device is likely to provide the patient with significant long-term pain relief. If the device is so certified, Medicare Part B will cover purchase of the TENS device.
If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that’s included in original Medicare Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. To find out whether your Medicare Part C plan has expanded coverage for a TENS device, contact the plan directly.
What Medicare Pays
Medicare Part B pays 80 percent of the Medicare-approved amount for the rental or purchase of a covered TENS device.
Under a Medicare Part C plan, co-payments for a TENS device may be different than under Medicare Part B. To find out what the copayments are for a TENS device under your Medicare Part C plan, contact the plan directly.
Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:
- The care must be “medically necessary.” This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?
- The care must be performed or delivered by a healthcare provider who participates in Medicare.
For the patients who are unable to have their TENS products covered by insurance, many TENS products, including the very popular Wi Touch TENS unit, can be purchased from MyMedSupply without needing a prescription at a very competitive price. Like those covered through Medicare, MyMedSupply’s Wi Touch TENS unit is able to provide pain relief in the comfort of a home, with the added convenience of not requiring a prescription or having to deal with jumping through hoops to have your insurance cover it.