The TRICARE Health program used throughout the U.S. Department of Defense health care system has disallowed transcutaneous electrical nerve stimulation — TENS — as a reimbursable treatment for low back pain. And in another recent shift, the DoD agency that oversees TRICARE has decided that dry needling will not be covered if it's the sole purpose for a visit.

The TENS decision was announced by the Defense Health Agency on February 26 and is effective June 1, 2020. In the notice of the change, the DoD says the TRICARE policy manual will now list TENS as an "unproven" treatment for low back pain and thus not eligible for coverage. Until now, TRICARE contractors were allowed to decide whether TENS was medically necessary for treatment of LBP.

According to a recent article in Military.com, DoD arrived at its decision after reviewing multiple studies that found weak evidence for the effectiveness of TENS for LBP, with a TRICARE official telling the site that the findings indicated that "TENS for lower back pain is no more effective than … placebo."

But the changes don't stop there. The revised TRICARE policy manual also lists dry needling as an "unproven" treatment — not just for LBP, but for any condition.

The change means that TRICARE will not cover a PT visit if dry needling is the "sole purpose" for the session. This policy is effective immediately.

TRICARE serves active duty and retired service members and their families worldwide.

"APTA is disappointed in the Defense Health Agency’s decision and questions some of the evidence used to support its decision, and this doesn't change our commitment to advocating for coverage for these services across payers," said Kara Gainer, APTA's director of regulatory affairs. "Patient access to the most appropriate, evidence-based care and respect for the clinical decision-making skills of physical therapists remain at the heart of our policy efforts."