Transcutaneous Electrical Nerve Stimulation (TENS) Unit - DME.ST.112.A

Evicore covers rental 2‑lead (E0720) and 4‑lead (E0730) TENS units and conductive garments (E0731) for acute post‑operative pain (≤30 days) and for chronic, intractable pain other than chronic low back pain (which is excluded). Coverage requires a monitored rental trial of 30–60 days with documented pain location/severity/duration, presumed etiology and failed prior treatments, a medical justification for 4‑lead over 2‑lead, prescription and specific medical indications for conductive garments, and practitioner documentation of likely long‑term benefit for purchase, with standard contraindications (e.g., pregnancy, epilepsy, electronic implants) and rental supply rules applying.

"2-lead TENS (HCPCS E0720, A4557, A4595) is medically necessary when either: The individual has acute post-operative pain and both of the following: There have been 30 days or less since surgery. Th..."