CMS Pub. 100-03, ch. 1, § 160.13

Nerve Stimulation (TENS) and Neuromuscular Electrical Stimulation

(NMES)

(Rev. 173, Issued: 09-04-14, Effective: Upon Implementation: of ICD-10, Implementation: Upon Implementation of ICD-10)

Transcutaneous Electrical Nerve Stimulation (TENS) and/or Neuromuscular Electrical

Stimulation (NMES) can ordinarily be delivered to patients through the use of

conventional electrodes, adhesive tapes and lead wires. There may be times, however,

where it might be medically necessary for certain patients receiving TENS or NMES

treatment to use, as an alternative to conventional electrodes, adhesive tapes and lead

wires, a form-fitting conductive garment (i.e., a garment with conductive fibers which are

separated from the patients’ skin by layers of fabric).

A form-fitting conductive garment (and medically necessary related supplies) may be

covered under the program only when:

1. It has received permission or approval for marketing by the Food and Drug

Administration;

2. It has been prescribed by a physician for use in delivering covered TENS or NMES

treatment; and

3. One of the medical indications outlined below is met:

• The patient cannot manage without the conductive garment because there is such

a large area or so many sites to be stimulated and the stimulation would have to be

delivered so frequently that it is not feasible to use conventional electrodes,

adhesive tapes and lead wires;

• The patient cannot manage without the conductive garment for the treatment of

chronic intractable pain because the areas or sites to be stimulated are inaccessible

with the use of conventional electrodes, adhesive tapes and lead wires;

• The patient has a documented medical condition such as skin problems that

preclude the application of conventional electrodes, adhesive tapes and lead

wires;

• The patient requires electrical stimulation beneath a cast either to treat disuse

atrophy, where the nerve supply to the muscle is intact, or to treat chronic

intractable pain; or

• The patient has a medical need for rehabilitation strengthening (pursuant to a

written plan of rehabilitation) following an injury where the nerve supply to the

muscle is intact.

A conductive garment is not covered for use with a TENS device during the trial period

specified in §160.3 unless:

4. The patient has a documented skin problem prior to the start of the trial period; and

5. The A/B MAC (B)'s medical consultants are satisfied that use of such an item is

medically necessary for the patient.

(See conditions for coverage of the use of TENS in the diagnosis and treatment of

chronic intractable pain in §§160.3, 160.13, and 160.27, and the use of NMES in the

treatment of disuse atrophy in §150.4.)