A4630 — Replacement batteries, medically necessary, transcutaneous electrical stimulator, owned by patient
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Use validated outcome measures to document patient outcomes (length of life, quality of life, and functional ability).
- Clinical documentation must address both benefits and harms and demonstrate a net health outcome for the condition being treated.
- Follow-up over months to monitor symptoms, change in disease status, morbid events, quality of life, and treatment-related morbidity when electromagnetic therapy is used.
- Clinical documentation should address relevant wound outcomes (symptoms, disease status, morbid events, QOL, treatment-related morbidity) during follow-up.
Key Coverage Criteria
- TENS units are consideredmedically necessarywhen prescribed as a treatment for pain for those who have not responded to other modalities, in the following situations:
- Pain related to musculoskeletal conditions;or
- Pain associated with active or post trauma injury.
- TENS garments are consideredmedically necessarywhen:
- The TENS criteria above have been met;and
- Conventional electrodes, adhesive tapes, and lead wires cannot be used because:A large area or many sites will be stimulated;orThe areas or sites to be stimulated are inaccessible;orA documented medical condition, for example but not limited to, presence of a skin disorder.
6 Active Policies
ANTHEM-CG-DME-04 — CG-DME-04 Transcutaneous Electrical Nerve Stimulation
BCBSIL-MED201.027 — Electrostimulation and Electromagnetic Therapy for Treating Wounds
BCBSMT-MED201.027 — Electrostimulation and Electromagnetic Therapy for Treating Wounds
BCBSNM-MED201.027 — Electrostimulation and Electromagnetic Therapy for Treating Wounds
BCBSOK-MED201.027 — Electrostimulation and Electromagnetic Therapy for Treating Wounds
Related Codes
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