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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 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. 
 
    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. 
 
    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. 
 
    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. 
 
Supplies 
 
Separate allowance will be made for replacement supplies when they are reasonable and necessary and are used 
with a covered TENS. Usual maximum utilization is: 
 
    2 TENS leads - a maximum of one unit of A4595 per month. 
    4 TENS leads - a maximum of two units of A4595 per month. 
 
If the use of the TENS unit is less than daily, the frequency of billing for the TENS supply code should be 
reduced proportionally. 
 
Replacement of lead wires (A4557) more often than every 12 months would rarely be reasonable and 
necessary. 
 
A conductive garment (E0731) used with a TENS unit is rarely reasonable and necessary, but is covered only if 
all of the following conditions are met: 
 
    It has been prescribed by the treating practitioner for use in delivering covered TENS treatment. 
    One of the medical indications outlined below is met: 
        The beneficiary cannot manage without the conductive garment because: 
            There is such a large area or so many sites to be stimulated, and 
            The stimulation would have to be delivered so frequently that it is not feasible to use conventional 
electrodes, adhesive tapes, and lead wires. 
        The beneficiary cannot manage without the conductive garment for the treatment of chronic intractable 
pain because the areas or sites to be stimulated are inaccessible with the use of conventional electrodes, 
adhesive tapes, and lead wires. 
        The beneficiary has a documented medical condition, such as skin problems, that preclude the application 
of conventional electrodes, adhesive tapes, and lead wires. 
        The beneficiary requires electrical stimulation beneath a cast to treat chronic intractable pain. 
 
A conductive garment is not covered for use with a TENS device during the trial period unless: 
 
    The beneficiary has a documented skin problem prior to the start of the trial period, and 
    The TENS is reasonable and necessary for the beneficiary. 
 
If the criteria above are not met for E0731, it will be denied as not reasonable and necessary. 
 
Reimbursement for supplies is contingent upon use with a covered TENS unit. Claims for TENS supplies 
provided when there is no covered TENS unit will be denied as not reasonable and necessary. 
 
Effective for claims with dates of service on or after June 8, 2012 supplies provided for use with a previously 
covered TENS unit used for CLBP (not as part of an approved study) are not eligible for reimbursement. These 
supply claims will be denied as not reasonable and necessary. 
 
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.