Transcutaneous Electrical Joint Stimulation Devices (TEJSD) - Policy Article

**NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES**

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. Information provided in this policy article relates
to determinations other than those based on Social Security Act 1862(a)(1)(A)
provisions (i.e. "reasonable and necessary").

A Transcutaneous Electrical Joint Stimulation Device (TEJSD) is covered under
the Durable Medical Equipment benefit (Social Security Act 1861(s)(6)). In
order for a beneficiary's equipment to be eligible for reimbursement the
reasonable and necessary (R&N) requirements set out in the related Local
Coverage Determination must be met. In addition, there are specific statutory
payment policy requirements, discussed below, that also must be met.

The DME benefit limits the coverage of DME items to those used the
beneficiary's home. Provision of TEJSD to beneficiaries in a Place of Service
or facility considered to be other than home will be denied as statutorily
non-covered. This includes a TEJSD incorporated into or used with any type
brace (see below).

Braces are covered under the Braces benefit (Social Security Act 
1861(s)(9)). Coverage of items under the Braces benefit is not limited to the
home.

Use of a TEJSD with a brace does not change the benefit category for the TEJSD
device or of the brace. A TEJSD/brace combination does not extend the DME
Benefit limitation of use in the home.

Refer to the applicable brace Local Coverage Determination and related Policy
Article for information about coverage requirements for braces.

**REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO Final Rule 1713 (84 Fed.
Reg Vol 217)**

Final Rule 1713 (84 Fed. Reg Vol 217) requires a face-to-face encounter and a
Written Order Prior to Delivery (WOPD) for specified HCPCS codes. CMS and the
DME MACs provide a list of the specified codes, which is periodically updated.
The required Face-to-Face Encounter and Written Order Prior to Delivery List
is available [here](https://www.cms.gov/Research-Statistics-Data-and-
Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-
Review/FacetoFaceEncounterRequirementforCertainDurableMedicalEquipment).

Claims for the specified items subject to Final Rule 1713 (84 Fed. Reg Vol
217) that do not meet the face-to-face encounter and WOPD requirements
specified in the LCD-related Standard Documentation Requirements Article
(A55426) will be denied as not reasonable and necessary.

If a supplier delivers an item prior to receipt of a WOPD, it will be denied
as not reasonable and necessary. If the WOPD is not obtained prior to
delivery, payment will not be made for that item even if a WOPD is
subsequently obtained by the supplier. If a similar item is subsequently
provided by an unrelated supplier who has obtained a WOPD, it will be eligible
for coverage.

**POLICY SPECIFIC DOCUMENTATION REQUIREMENTS**

In addition to policy specific documentation requirements, there are general
documentation requirements that are applicable to all DMEPOS policies. These
general requirements are located in the DOCUMENTATION REQUIREMENTS section of
the LCD.

Refer to the LCD-related Standard Documentation Requirements article, located
at the bottom of this Policy Article under the Related Local Coverage
Documents section for additional information regarding GENERAL DOCUMENTATION
REQUIREMENTS and the POLICY SPECIFIC DOCUMENTATION REQUIREMENTS discussed
below.

**CODING GUIDELINES**

A transcutaneous electrical joint stimulation device (TEJSD) coded (E0762) is
a noninvasive device that delivers electrical stimulation intended to reduce
the level of pain and symptoms associated with arthritis in a joint. TEJSD may
have variation in the parameters of the current, how the current is applied,
etc.

A TEJSD coded E0762 must be distinguished from other electrical stimulators
(e.g., neuromuscular stimulators, functional electrical stimulators and
transcutaneous electrical nerve stimulators, etc.) which also have unique
HCPCS codes and are used to directly stimulate muscles and/or nerves. The
appropriate applicable HCPCS code for these devices must be used.

TEJSD is sometimes provided in combination with an orthosis (brace). When
these items are provided in combination, the TEJSD and brace are always coded
separately, using the codes assigned to each individual product. Braces
designed to accommodate placement of electrodes and/or lead wires, that
contain integrated electrodes and/or lead wires, storage for the TEJSD, etc.
are considered braces, not supplies or accessories to the TEJSD and must be
coded with the HCPCS code that appropriately describes the brace.

If the electronics are incorporated into a brace, the item is no longer
considered a brace. Rather it is DME if it meets the benefit requirements for
the DME Benefit or is statutorily non-covered (no benefit) if it does not.

Code A4465 is used for replacement only of any wrap/strap used to position and
hold electrodes used with TEJSD in place. Use of this code for replacement of
wraps/straps used with a brace is incorrect coding.

The supply allowance (A4595) includes electrodes (any type), conductive paste
or gel (if needed, depending on the type of electrode), tape or other adhesive
(if needed, depending on the type of electrode), adhesive remover, skin
preparation materials, batteries (any type, single use or rechargeable), and a
battery charger (if rechargeable batteries are used). One unit of service
includes all necessary supplies for one month's prescribed use of the device.
Separate billing for individual supplies is considered unbundling.

Codes A4556 (Electrodes, [e.g., apnea monitor], per pair) and A4558
(Conductive paste or gel), are not valid for claim submission to the DME MAC.
Code A4595 should be used instead.

For code A4557, one unit of service is for lead wires going to two electrodes.

Other supplies, including but not limited to the following, will not be
separately allowed: adapters (snap, banana, alligator, tab, button, clip),
belt clips, adhesive remover, additional connecting cable for lead wires,
carrying pouches, or covers.

The only products which may be billed using code E0762 are those for which a
written Coding Verification Review has been made by the Pricing, Data Analysis
and Coding (PDAC) Contractor and subsequently published on the appropriate
Product Classification List. Suppliers may not submit claims using E0762 for
any other item.

Claims for unlisted items using HCPCS code E0762 will be denied as incorrect
coding.

Suppliers should contact the PDAC for guidance on the correct coding of these
items.