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

Covered: Evicore covers 2‑lead TENS (E0720/A4557/A4595) for acute post‑operative pain within 30 days of surgery or for chronic intractable pain (excluding low back), and covers 4‑lead TENS (E0730/...) only when there is documented medical justification that a 2‑lead cannot meet the patient’s needs; chronic intractable low back pain and use beyond 30 days post‑op are excluded. Key requirements: acute use must be ≤30 days post‑surgery and used in addition to or instead of medication with surgery date documented; chronic use requires ≥3 months duration, failure of standard treatments, a documented 30‑day trial with outcomes, clinical justification (including why 2‑lead is inadequate for 4‑lead), and appropriate HCPCS coding.

"HCPCS Codes (E0720, A4557, A4595) - A 2 lead TENS unit is indicated when either:"

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