Assessing Patient's Suitability for Electrical Nerve Stimulation Therapy

TENS and PENS are covered when used as diagnostic trials to assess suitability for continued transcutaneous or implanted nerve stimulator therapy, with effectiveness typically determined within a one-month trial monitored by a physician or physical therapist. PENS is covered only when performed by a physician in an appropriate outpatient setting; rental of TENS during trials may be paid if recommended by the clinician but combined payments have a cap, and services continued beyond one month require documented medical necessity; ongoing clinic-based therapeutic treatments are excluded from coverage.

"Transcutaneous electrical nerve stimulation (TENS) may be furnished on a trial basis to assess a patient's suitability for ongoing transcutaneous or implanted nerve stimulator therapy, with effecti..."

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