E0762 — Transcutaneous electrical joint stimulation device system, includes all accessories
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- A Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted for the item.
- For DMEPOS base items that require a Written Order Prior to Delivery (WOPD), the supplier must have received a signed WOPD before delivering the item to the beneficiary.
- When separately billed options, accessories, and/or supplies are required, the WOPD must list the base item and may list those separately billed items prior to delivery.
- Suppliers are required to maintain Proof of Delivery (POD) documentation and make it available to the Medicare contractor upon request.
Key Coverage Criteria
- PENS (ICD-10 codes covered if selection criteria are met): M79.2 Neuralgia and neuritis, unspecified [neuropathic pain]
- Transcutaneous Electrical Nerve Stimulators (TENS) medically necessary when used as an adjunct or as an alternative to the use of drugs either in the treatment of acute post-operative pain in the first 30 days after surgery, or for certain types of chronic, intractable pain not adequately responsive to other methods of treatment including, as appropriate, physical therapy and pharmacotherapy.
- When TENS is used for acute post-operative or chronic intractable pain, initial medically necessary use is for a trial period of at least 1 month but not to exceed 2 months, monitored by the physician to determine effectiveness.
- Form-fitting conductive garment medically necessary DME only when it has been approved for marketing by the FDA, has been prescribed by a doctor for delivering TENS for one of the medically necessary indications listed above, and any of the following criteria is met: the member cannot manage without the conductive garment due to large area or number of sites to be stimulated and frequent delivery is required; or the member has a medical need for rehabilitation strengthening following an injury w [...]
- G90.50 - G90.59 Complex regional pain syndrome I (CRPS I) (covered if selection criteria are met for peripherally implanted nerve stimulators)
- S14.101S - S14.159S; S14.2xxS - S14.9xxS; S24.101S - S24.159S; S24.2xxS - S24.9xxS; S34.101S - S34.139S; S34.21xS - S34.9xxS; S44.8x1S - S44.92xS; S54.8x1S - S54.92xS; S64.8x1S - S64.92xS; S74.8x1S - S74.92xS; S84.801S - S84.92xS; S94.8x1S - S94.92xS (spinal cord injury, injury to nerve root(s), spinal plexus(s), and other nerves of trunk, injury to peripheral nerve of shoulder girdle and upper limb, or injury to peripheral nerve of pelvic girdle and lower limb, sequela) — covered if selection c [...]
10 Active Policies
L34821 — Transcutaneous Electrical Joint Stimulation Devices (TEJSD)
J19
AETNA-CPB-0362 — Spasticity Management
ANTHEM-DME.00011 — DME.00011 Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices
BCBSIL-MED201.042 — Electrical and Electromagnetic Stimulation for the Treatment of Arthritis
BCBSMT-MED201.042
Related Codes
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