For any item to be covered by Medicare, it must 1) be eligible for a defined
Medicare benefit category, 2) be reasonable and necessary for the diagnosis or
treatment of illness or injury or to improve the functioning of a malformed
body member, and 3) meet all other applicable Medicare statutory and
regulatory requirements.

The purpose of a Local Coverage Determination (LCD) is to provide information
regarding "reasonable and necessary" criteria based on Social Security Act 
1862(a)(1)(A) provisions.

In addition to the "reasonable and necessary" criteria contained in this LCD
there are other payment rules, which are discussed in the following documents,
that must also be met prior to Medicare reimbursement:

  * The LCD-related Standard Documentation Requirements Article, located at the bottom of this policy under the Related Local Coverage Documents section.
  * The LCD-related Policy Article, located at the bottom of this policy under the Related Local Coverage Documents section.
  * Refer to the Supplier Manual for additional information on documentation requirements.
  * Refer to the DME MAC web sites for additional bulletin articles and other publications related to this LCD.

For the items addressed in this LCD, the "reasonable and necessary" criteria,
based on Social Security Act  1862(a)(1)(A) provisions, are defined by the
following coverage indications, limitations and/or medical necessity.

DEFINITIONS

For purposes of this LCD the terms "arthritis", "degenerative joint disease",
and "osteoarthritis" are used interchangeably and refer to the disease
osteoarthritis. Arthritis due to other etiologies such as rheumatoid disease,
gout, psoriasis, etc. (not all-inclusive) is not included by the use of these
terms.

Transcutaneous electrical joint stimulation is administered by a noninvasive
device that delivers electrical stimulation intended to reduce the level of
pain and symptoms associated with arthritis in a joint. Devices that provide
electrical stimulation have considerable variation in the parameters of the
current, how the current is applied, etc. This LCD is applicable regardless of
the individual characteristics of any given device.

INDICATIONS

There is insufficient published clinical evidence to establish that treatment
with Transcutaneous Electrical Joint Stimulation Devices (TEJSD) (HCPCS code
E0762) meets the requirements to be considered reasonable and necessary for
the treatment of osteoarthritis or any other condition. Claims for TEJSD (code
E0762) will be denied as not reasonable and necessary.

There is insufficient published clinical evidence to establish that treatment
with other electro-magnetic devices such as transcutaneous electrical
stimulation devices (TENS), neuromuscular stimulators (NMES), functional
electrical stimulators (FES), light treatment devices (any type), infrared
treatment devices (any type), etc. (not all-inclusive), singly or in any
combination, meet the requirements to be considered reasonable and necessary
for the treatment of osteoarthritis. Claims for these items will be denied as
not reasonable and necessary.

TEJSD COMBINED WITH AN ORTHOSIS (Brace)

TEJSD is currently supplied as a stand-alone device or for use concurrently or
in combination with a brace. Braces are separate DMEPOS items with independent
coverage requirements that are unrelated to the coverage of TEJSD. When TEJSD
is used concurrently or in combination with any type of brace, there no
reimbursement possible for the TEJSD device. Refer to the applicable LCD and
related Policy Article for information about the payment requirements for
reimbursement of braces.

ACCCESSORIES / SUPPLIES

Claims for supplies used with a base item are not payable when the base item
is not covered. Since code E0762 is not considered to be reasonable and
necessary (see above), claims for codes A4465, A4495, A4557, and A4595 to be
used with code E0762 will be denied as not reasonable and necessary.

There is no evidence of effectiveness of a TEJSD (E0762) when used with a
conductive garment (E0731). Claims for code E0731 billed for use with an E0762
will be denied as not reasonable and necessary.

CODING

Refer to the related Policy Article CODING GUIDELINES section for additional
information regarding coding of E0762.

GENERAL

A Standard Written Order (SWO) must be communicated to the supplier before a
claim is submitted. If the supplier bills for an item addressed in this policy
without first receiving a completed SWO, the claim shall be denied as not
reasonable and necessary.

For Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)
base items that require a Written Order Prior to Delivery (WOPD), the supplier
must have received a signed SWO before the DMEPOS item is delivered to a
beneficiary. If a supplier delivers a DMEPOS item without first receiving a
WOPD, the claim shall be denied as not reasonable and necessary. Refer to the
LCD-related Policy Article, located at the bottom of this policy under the
Related Local Coverage Documents section.

For DMEPOS base items that require a WOPD, and also require separately billed
associated options, accessories, and/or supplies, the supplier must have
received a WOPD which lists the base item and which may list all the
associated options, accessories, and/or supplies that are separately billed
prior to the delivery of the items. In this scenario, if the supplier
separately bills for associated options, accessories, and/or supplies without
first receiving a completed and signed WOPD of the base item prior to
delivery, the claim(s) shall be denied as not reasonable and necessary.

An item/service is correctly coded when it meets all the coding guidelines
listed in CMS HCPCS guidelines, LCDs, LCD-related Policy Articles, or DME MAC
articles. Claims that do not meet coding guidelines shall be denied as not
reasonable and necessary/incorrectly coded.

Proof of delivery (POD) is a Supplier Standard and DMEPOS suppliers are
required to maintain POD documentation in their files. Proof of delivery
documentation must be made available to the Medicare contractor upon request.
All services that do not have appropriate proof of delivery from the supplier
shall be denied as not reasonable and necessary.

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