23 Miss. Code. R. 209-1.41 - Transcutaneous Electrical Nerve Stimulator (TENS)
A.
Medicaid defines a transcutaneous electrical nerve stimulator (TENS) as a
device that utilizes electrical current delivered through electrodes placed on
the surface of the skin to decrease the patient's perception of pain by
inhibiting the transmission of afferent pain nerve impulses and/or stimulating
the release of endorphins.
B.
Medicaid covers TENS for all beneficiaries when prior authorized by the
Utilization Management and Quality Improvement Organization (UM/QIO), the
Division of Medicaid or designated entity, for rental up to purchase amount, or
purchase when indicated when ordered by a physician and one (1) of the
following criteria is met:
1. The TENS unit
is being used for acute post-operative pain, the beneficiary is within thirty
(30) days post-op, other treatment modalities have failed and the patient is
being treated at home rather than an inpatient hospital. Approval is limited to
thirty (30) days rental.
2. The
beneficiary has intractable chronic pain of at least three (3) months duration
from date of onset and a history of failed response to other treatment
modalities. A thirty (30) to sixty (60) day trial period is required.
C. Medicaid covers for a
conductive garment to be used with a TENS unit when ordered by the practitioner
only if one (1) of the following apply:
1.
The beneficiary 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.
2. The beneficiary 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.
3. The beneficiary has a documented medical
condition, such as a skin condition, that precludes the application of
conventional electrodes, adhesive tapes, and lead wires.
4. The beneficiary requires electrical
stimulation beneath a cast to treat chronic intractable
pain.
D. Medicaid
requires for purchase to be considered, the practitioner must provide a copy of
the re-evaluation performed at the end of the trial period and documentation
that the patient is likely to derive significant therapeutic benefit from
continuous use of the unit over a long period of time.
E. If a four (4) lead TENS unit is ordered,
the practitioner must document why two (2) leads are insufficient to meet the
patient's needs.
Notes
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