TENS

Transcutaneous Electrical Nerve Stimulation (TENS) is a trusted, clinically-proven, noninvasive therapy used for the management of, and relief from, chronic (long-term) intractable pain and post-surgical and post-trauma acute pain.

Indications for TENS

  • Relief of chronic (long-term) intractable pain
  • Reduce Muscle Guarding
  • Relief of post-surgical acute pain
  • Relief of post-trauma acute pain

Documentation

To ensure the likelihood of reimbursement, justification of medical necessity for TENS must be substantiated; the following documentation should be provided to both CriterionMed and the patient’s insurance provider

  • Letter of Medical Necessity (prescription, diagnosis codes, ABN, etc.)
  • Treatment Records should include (if applicable):
    1. Therapy History – including records relative to treatment
    2. Presenting Symptoms and Complaints
    3. Diagnosis of Condition(s)
    4. Lab Test Results
    5. X-Rays/MRIs
    6. Patient Follow-Up Progress (i.e. successful use, compliance, etc.)
    7. Recommended Plan of Care

Ultimately, the clinician must exercise his or her own judgement when documenting treatment plans assessment.

Please contact Criterion if any of the above forms are required. A Criterion Representative will contact you directly if additional information regarding claims submission is required.

Conditions ICD-10 Code
Conditions – Neck and Back
Cervical Spondylosis M47812
Cervical Disc Degeneration M5030
Cervical Disc Displacement M5020
Cervical Radiculopathy M5412
Cervicalgia M542
Cervicothoracic Radiculopathy M5413
Dorsalgia/Back Pain M549
Ligament Strain in Thoracic Spine S233XXA
Lumbago M545
Lumbar Disc Degeneration M5136
Lumbar Disc Displacement M5126
Lumbar Radiculopathy M5416
Lumbosacral Disc Degeneration M5137
Lumbosacral Disc Displacement M5127
Lumbosacral Radiculopathy M5417
Lumbosacral Spondylosis M47817
Neuralgia/Neuritis M792
Other Back Symptoms M5408
Pain in Thoracic Spine M546
Post Laminectomy Syndrome M961
Sciatica M5430
Spinal Stenosis/Lumbar M4806
Sprain/Lumbar Region S335XXA
Thoracic Disc Degeneration M5134
Thoracic Radiculopathy M5414
Thoracolumbar Disc Degeneration M5135
Thoracolumbar Radiculopathy M5415
Conditions – Upper Extremity
Joint Pain/Shoulder M25519
Lateral Epicondylitis M7710
Pain in Limb M79609
Sprain/Rotator Cuff S43429A
Sprain/Supraspinatus S4380XA
Conditions – Lower Extremity
Chondromalacia Patella M2240
Joint Pain/Leg M25569
Joint Pain/Pelvis M25559
Local Osteoarthrosis/Leg M1710
Osteoarthrosis/Leg M179
Pain in Limb M79609
Sprain/Cruciate Ligament (Knee) S83509A
Other Conditions
Muscle/Ligament DIS NEC M629
Myalgia M791
Myositis M609
Post Surgical State Z9889

Additional Billing Codes

  • E0730 – Billing Code for the TENS unit itself.
  • 97002 – Physical therapy re-evaluation
  • 64550 – Application of surface (Transcutaneous) Neurostimulator – TENS/NMS. This is commonly referred to as “fitting.” The fitting process entails diagnosing, and instructing the patient as to where to place electrodes (box in area of treatment) and inform them of warning, etc.
  • 97032 – Application of a modality to one or more areas; electrical stimulation (manual), each 8-20 minutes (per area) [Modality used to apply electrical current to a specific area. Attended electrical stimulation is also referred to as manual stimulation Attended stimulation calls for the application of stimulation for shorter or more specific time frames and at varying degrees of current.] Example: If patient has two areas of pain (i.e. cervical and lumbar) you would spend 8-20 minutes on each area and bill for your time spent on each area.
  • 97014 – Electrical Stimulation (unattended) – (one or more areas) [The application of electrical stimulation to specific areas. The term unattended means that the patient is positioned and the appropriate type of stimulation is applied to an area, over a specific time period. Nerve and muscle stimulation can be useful in any disorder in which the patient has lost or never had adequate voluntary control over skeletal muscle. Until such time as the patient achieves useful control, it is most helpful to use this type of stimulation along with other interventions such as passive exercise.

Criterion has compiled all applicable coding information regarding Criterion Products for your convenience. The provider is responsible for determining coverage, submitting appropriate codes, modifiers, and charges for the services rendered. The clinician must use independent judgement when deciding which codes most accurately describe the products and/or services provided.

Criterion makes no representation, guarantee, or warranty, expressed or implied, that the information contained within this document is free of errors or that the use of this information will prevent differences of opinion or disputes with third-party payers, and will bear no responsibility or liability for the results or consequences of its use.