intent of this policy is to implement minimum standards for all vendors
supplying TENS/NMES units to Ohio’s injured workers and to establish
standardized criteria for the medical indications for the use of TENS/NMES.
TENS: A device that utilizes
electrical current delivered through electrodes placed on the surface of
the skin to decrease the patient’s perception of pain by inhibiting the afferent
pain nerve impulses and/or stimulating the release of endorphins.
NMES: A device which transmits an
electrical stimulus to muscle groups and causes the muscle to contract.
Criteria for TENS/NMES Units
criteria apply to all vendors supplying TENS/NMES units to Ohio’s injured
Minimum Technical and Educational Criteria
and NMES units
Device must produce constant current.
Constant current maintains waveform as it is driven through the skin. It allows
the current to be delivered in a uniform pattern, increasing the comfort level
for the patient. Breakdown of the waveform may result in increased skin
irritation and burning.
Requirements: a.) Impedance must be no greater
than 75 ohms. Ideal impedance is 30-60 ohms. b) Re-usable electrodes
must be able to be reused 10-15 times depending on skin condition.
Rationale: a.) Increased ohms cause the
need for higher current levels for maximum functioning. b.) Re-use of electrodes
provides for increased efficiency and decreased costs.
Requirement: TENS and NMES units must be
personally fitted and face to face instruction given by a direct employee of
the billing provider within 5 business days of the request for the unit,
payable one time per injured worker.
are more apt to use the TENS or NMES unit correctly and to have fewer problems
and increased pain relief if given face to face instruction rather than if
given written or telephonic instruction.
Requirement: Prior authorization is required
to obtain monthly supplies. Claimants who have TENS units must complete and
submit to the TENS provider a monthly written request for specific supplies
needed in the following month. The written request must be initiated and
signed by the claimant and received by the TENS provider prior to delivery of
supplies and/or equipment. The MCO shall provide education to the injured
worker and parties to the claim on the injured worker signature requirement for
monthly TENS supplies when a C-9 is authorized for TENS supplies. The TENS
provider will provide education to the injured worker on the signature
requirement for monthly TENS supplies. The TENS provider shall then deliver the
supplies and bill the BWC, MCO, QHP or self-insuring employer after the
claimant’s written request is received. The provider shall retain the original
written request for supplies in accordance with the time frames set forth in
4123-6-45.1 of the Administrative Code. The bill must indicate the actual date
of service, reflecting the date that services or supplies were provided. The
BWC, MCO, QHP or self-insuring employer may adjust bills upon audit if the
audit disclosed that provider’s failure to comply with 4123-6-43 of the
phone calls must be placed by the vendor to each injured worker to gather usage
information, to offer additional instruction, gather supply quantity
information and to inform the injured worker that a written request for the
following month’s supplies is required.
shall monitor the vendor for provision of a monthly progress report including
Physician of Record documentation.
amounts of medically necessary supplies for the following month will be
provided. Billing provider will not issue supplies unless the injured worker
has provided a signed written request and the supplies are necessary and
Medical Necessity Criteria
TENS for Chronic Pain
authorization by BWC, MCO, or self-insured employer is required for TENS rental
or purchase. Payment for a transcutaneous electrical nerve stimulator (TENS) is
covered for the treatment of patients with chronic, intractable pain who meet
the following criteria:
from the physician of chronic pain that has been present for three months;
from the physician of the location of pain, duration of time patient has had
pain, and the presumed cause of the pain;
from the physician of other modalities that have been tried and failed;
period of only one month to determine the effectiveness of TENS unit.
purchase of a TENS unit for chronic pain, the following documentation must be
present in the physician’s records at the conclusion of the 30 day trial:
duration of use of TENS;
TENS units modulating pain
TENS for Acute Post-operative Pain
rental is generally limited to 30 days beyond surgery. For reimbursement beyond
30 days, the physician must provide medical documentation for justification.
Neuromuscular Stimulators (NMES)
device provides an electrical stimulus directly to the muscle or motor nerve of
the muscle, causing the muscle to contract. The goal is to stimulate
denervated muscle to prevent atrophy or degeneration and to strengthen/train
healthy muscles that are at risk of atrophy from immobilization or disuse due
to injury. Prior authorization by BWC, MCO, or self-insured employer is
required prior to NMES rental or purchase.
Medical Director or an MCO physician consultant is required to review each
request for home rental or purchase of NMES based on medical necessity and BWC
of NMES devices for home use for the treatment/prevention of muscle atrophy
requires the following conditions be met:
has suffered partial or complete loss of function in one or more muscles
because of an injury to a peripheral nerve or nerve root, and
is substantiated by EMG confirming the nerve injury. The EMG must
demonstrate positive waves and/or fibrillation in the affected muscles.
will reimburse NMES and also Functional Electrical Stimulation (FES) to enhance
walking of injured workers with spinal cord injuries (SCI) who meet all the
paraplegia of both lower limbs (ICD-9 344.1);
to use the device on a long-term basis;
motivation, commitment and cognitive ability to use the device for walking;
a physical therapy training program of a minimum of 30 sessions with the NMES
unit over a 3 month period;
motor units (L1 and below) both muscle and peripheral nerve;
of brisk muscle contraction to NMES and sensory perception of electrical
stimulations sufficient for muscle contraction;
joint stability for weight bearing at upper and lower extremities with
demonstration of balance and control to maintain an upright support posture
transfer independently and demonstration of standing independently for at least
of hand and finger function to manipulate controls;
6-month post recovery spinal cord injury and restorative surgery; and
hip and knee degenerative disease and no history of long bone fracture
secondary to osteoporosis
appropriate Level I CPT® code to be billed to MCO/BWC for the required physical
therapy with the NMES unit is 97116-gait training.
for walking is contraindicated for SCI injured workers with any of the
pacemakers or cardiac defibrillators;
scoliosis or severe osteoporosis;
or cancer at the area of stimulation
4123-6-43 Payment of TENS and NMES
will be approved for a TENS unit for treatment of allowed conditions in a claim
directly resulting from an allowed industrial injury or occupational disease,
as provided in this rule.
authorization is required for TENS units and supplies.
who requires a TENS unit will be provided only one unit at a time.
For each TENS
there is a trial period of no more than 30 days. This trial period is to
evaluate the medical necessity and effectiveness of the TENS treatment.
treatment will be discontinued at the end of 30 days if it has not proven to be
medically necessary or effective.
of rental costs will be considered only for the trial period that the TENS unit
was actually used before treatment was discontinued.
apply all rental payments previously made to the purchase price of the TENS
A TENS unit,
furnished and purchased for the claimant, is not the personal property of the claimant,
but remains the property of BWC, or self-insuring employer.
BWC or self-insuring
employer, reserves the right to reclaim and recover the TENS unit from the
claimant at the completion of the course of TENS treatment.
Once a TENS
unit is purchased, BWC
, or self-insuring employer will reimburse for
repair or replacement of the unit upon the submission of request from
the physician of record or treating provider that includes medical
documentation substantiating the continued medical necessity and effectiveness
of the unit.
TENS provider shall maintain the following records and make them available for
audit upon request:
worker’s signed monthly written requests;
the provider’s wholesale purchase of TENS supplies or equipment; and,
delivery of supplies to injured workers and the delivery or return of TENS
request, the provider shall supply copies of the record information to the
requester at no cost. Failure to provide the requested records will result in
denial or adjustment of bills related to these records.
The above criteria listed in ORC 4123-6-43 Payment of Transcutaneous Electrical
Nerve Stimulators, is being applied to the payment neuromuscular units (NMES)
effective March 1, 2004.
coding and reimbursement
will reimburse for TENS and NMES units and supplies at the current fee schedule