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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that the practitioner ordering the Transcutaneous Electrical Nerve Stimulators (TENS) unit and 
related supplies must be the treating practitioner for the disease or condition justifying the need for the TENS 
unit. 
 
A TENS is covered for the treatment of beneficiaries with chronic, intractable pain or acute post-operative pain 
when one of the following coverage criteria, I-III, are met. 
 
    I. Acute Post-operative Pain 
 
    TENS is covered for acute post-operative pain. Coverage is limited to 30 days (one month's rental) from the 
day of surgery. Payment will be made only as a rental. 
 
    A TENS unit will be denied as not reasonable and necessary for acute pain (less than three months duration) 
other than for post-operative pain. 
 
II. Chronic Pain Other than Low Back Pain 
 
TENS is covered for chronic, intractable pain other than chronic low back pain when all of the following 
criteria must be met: 
 
    The presumed etiology of the pain must be a type that is accepted as responding to TENS therapy. Examples 
of conditions for which TENS therapy is not considered to be reasonable and necessary are (not all-inclusive): 
        headache 
        visceral abdominal pain 
        pelvic pain 
        temporomandibular joint (TMJ) pain 
    The pain must have been present for at least three months. 
    Other appropriate treatment modalities must have been tried and failed. 
 
TENS therapy for chronic pain that does not meet these criteria will be denied as not reasonable and necessary. 
 
III.     Chronic Low Back Pain (CLBP) 
 
    TENS therapy for CLBP is only covered when all of the following criteria are met: 
        The beneficiary has one of the diagnosis codes listed. (Refer to the ICD-10 code list in the LCD-related 
Policy Article for applicable diagnoses.) 
        The beneficiary is enrolled in an approved clinical study that meets all of the requirements set out in NCD 
?160.27 (CMS Internet Only Manual 100-03, Chapter 1). Refer to the APPENDICES section for additional 
information about approved clinical studies. 
 
  TENS therapy for CLBP that does not meet these criteria will be denied as not reasonable and necessary. 
 
 General Requirements for chronic pain (II) and CLBP (III) 
 
When used for the treatment of chronic, intractable pain described in section II, the TENS unit must be used by 
the beneficiary on a trial basis for a minimum of one month (30 days), but not to exceed two months. The trial 
period will be paid as a rental. The trial period must be monitored by the treating practitioner to determine the 
effectiveness of the TENS unit in modulating the pain. For coverage of a purchase, the treating practitioner 
must determine that the beneficiary is likely to derive significant therapeutic benefit from continuous use of the 
unit over a long period of time. 
 
A 4-lead TENS unit may be used with either 2 leads or 4 leads, depending on the characteristics of the 
beneficiary's pain. If it is ordered for use with 4 leads, the medical record must document why 2 leads are 
insufficient to meet the beneficiary?s needs. 
 
TENS used for CLBP as described in section III does not require a trial rental period or an assessment of 
effectiveness by the treating practitioner. Upon the beneficiary's enrollment into an approved study, the TENS 
is eligible for purchase. 
 
TENS used to treat CLBP is provided under limited coverage. Reimbursement is only available for 
beneficiaries who are enrolled in an approved clinical trial. CMS maintains a list of policies that require study 
participation as a condition of coverage on the CMS web site. For each policy the approved studies are listed 
and a link provided to the study on the clinicaltrials.gov web site. The clinicaltrials.gov identifier number 
required on each claim is listed on this site. 
 
You can find this information in Medicare's Local Coverage Determination (LCD): Transcutaneous Electrical 
Nerve Stimulators (TENS) (L33802). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.