• Tuesday, June 12, 2012RSS Feed

    CMS Retains Clinical Study Requirement in Final TENS Decision Memo

    Despite APTA's urging for continued Medicare coverage of TENS for chronic low back pain (CLBP) and additional research regarding the circumstances when the use of TENS for CLBP is effective, the Centers for Medicare and Medicaid Services (CMS) finalized the requirement of enrollment in an approved clinical study to receive coverage for TENS for CLBP.

    In its final decision memo, CMS said that the clinical study requirement is to support additional research on the use of TENS for CLBP, and this requirement will expire in 3 years. CMS says in the memo that based on its review of the evidence, "… we have determined that TENS is not reasonable and necessary for CLBP under 1862(a)(1)(A) of the Act. Neither the comments we received, nor the discussions that we have had with industry and investigators, have provided us with the persuasive scientific evidence to reach a different conclusion." Thus, at the expiration of the 3-year clinical study requirement, TENS for CLBP will not be covered, as it will be considered not reasonable and necessary.

    Links to APTA's comments and summary on the National Coverage Analysis Tracking Sheet for TENS for Chronic Low Back Pain can be found on APTA's Medicare Coverage Issues webpage.

    APTA members commented extensively on CMS's proposal memo in News Now coverage posted March 14 and April 3.


    Comments

    I hope CMS is prepared to limit coverage to opiodd medications for CLBP as well.
    Posted by Kevin Basile -> >JR]DK on 6/14/2012 12:06 PM
    Why wouldn't medicare take a look at side effects of opioid pain medications and compare them to those of TENS?
    Posted by Marina on 6/15/2012 7:24 PM
    Good for CMS, TENS is a temporary fix, if even that. And too many PT's abuse billable services, they slap everything they can on the patient regardless of if it works or not just to bill all they can. I hope CMS finds the truth and sticks to it.
    Posted by Travis on 6/15/2012 8:01 PM
    In response to Travis' comment: What about the PT's who go the extra mile for their patients simply because they care and want to help? It is of no benefit to us to bill for a TENS unit! There are simply those of us out there that want our patients to live with improved function and quality of life, and to have the OPTION for TENS for chronic pain to help them in doing so. CMS will never find the truth because they are obviously not looking for it.
    Posted by Lisa on 6/20/2012 10:12 PM
    In response to Travis' comment, I assure you TENS application is not a lucrative charge. That is the last thing a PT would be billing if we were teying to fraud the system.
    Posted by Russ on 6/22/2012 12:06 PM
    where can i find the guidelines on charging TENS?
    Posted by JC on 6/26/2012 11:09 AM
    As a PT with CLBP, who has been repeatedly refused insurance coverage for necessary services to manage my back pain, I regularly use a TENS instead of the usual prescribed painkillers which have deleterious side effects. TENS is clinically useful for both my patients and myself. By the way, I do NOT charge to apply TENS, it is part of treatments I already provide. TENS is a natural, effective modality to limit painful conditions which should be covered by insurance. It appears they would rather pay for addictive and dangerous drugs instead of natural pain management. When are PTs going to stand up for what works in our practice?
    Posted by Theresa A. Schmidt, DPT, MS,OCS on 7/2/2012 5:58 PM
    Personally as a physical therapist, I think that we need to consider the treatment of TENS as a viable treatment intervention for pain management for many multiple conditions not just CLBP that it has been successful in treating. I would also like to add that the electrotherapeutic modalities is a specialty practice area. The benefit that TENS has as an analgesic effect for pain management prior to surgery and post surgery has been crucial for patients/clients to help improve their daily functional activity. The possibility of postponing extensive surgical procedures with the assistance of non-pharmacological pain relief and the benefits that TENS serves in various areas of specialty practice for physical therapy I feel warrants possibility.
    Posted by Heidi Harris on 7/6/2012 10:01 AM
    According to a past report I read, I believe in JAMA, the second leading cause of death in the USA is prescription medication, only surpassed by heart attacks. I am unaware of any deaths caused by TENS.
    Posted by Dr Robert Donaldson DC, PT, OCS on 9/7/2012 4:29 PM
    Now that a clinical trial is a requirement, where does one go to find and authorized clinical trial to participate in?
    Posted by Jon Erbst on 5/8/2013 4:53 PM
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