Ohio Admin. Code 5160-10-15 - DMEPOS: transcutaneous electrical nerve stimulation (TENS) units
(A)
Definitions.
(1)
"Accessories" is
a collective term that encompasses but is not necessarily limited to the
following items:
(a)
Adapters;
(b)
Clips;
(c)
Additional connecting cable for lead
wires;
(d)
Carrying pouches; and
(e)
Covers.
(2)
"Supplies" is a
collective term that encompasses but is not necessarily limited to the
following items:
(a)
Electrodes of any type;
(b)
Lead
wires;
(c)
Conductive paste or gel;
(d)
Adhesive;
(e)
Adhesive
remover;
(f)
Skin preparation materials;
(g)
Batteries;
and
(h)
Battery charger for rechargeable
batteries.
(B)
Provider
requirement. A provider of transcutaneous electrical nerve stimulation (TENS)
units must have a physical location available for face-to-face fitting and
instruction purposes.
(C)
Coverage.
(1)
Payment may be made for a TENS unit on a
rental/purchase basis.
(2)
The default certificate of medical necessity (CMN) form
is the ODM 03402, "Certificate of Medical Necessity: Transcutaneous Electrical
Nerve Stimulation (TENS) Units" (rev. 7/2018). The CMN must include one of the
following statements of need:
(a)
For neurogenic pain, the following information:
(i)
An attestation
that the individual is experiencing intractable, nerve-related pain that has
lasted at least six months;
(ii)
An appropriate
supporting diagnosis; and
(iii)
An attestation
that the use of a comparable TENS unit for a trial period of at least thirty
days produced substantial relief from pain and, if applicable, enabled a
significant reduction in medication (e.g., muscle relaxants, narcotics,
analgesics); or
(b)
For post-operative pain, the following
information:
(i)
An attestation that treatment lasting no longer than
thirty days is needed for acute pain following surgery; and
(ii)
The date of
surgery.
(3)
Payment may be
made for the purchase of a TENS unit if the prescriber attests to the medical
necessity of continued treatment.
(4)
After a TENS unit
has been purchased for an individual, regardless of payment source, separate
payment may be made for necessary supplies, which must be dispensed only when
they are needed, at a frequency not to exceed once per month. The payment made
for supplies is an all-inclusive lump sum and does not depend on the number or
nature of items in a particular shipment. No separate payment is allowed for
individual supply items.
(5)
After a TENS unit has been purchased, no separate
payment is allowed for accessories.
(D)
Requirements,
constraints, and limitations.
(1)
A diagnosis of "chronic intractable pain" is not in
itself sufficient to warrant coverage.
(2)
Rental of a TENS
unit to treat intractable, nerve-related pain is limited to four months.
(3)
Rental
of a TENS unit to treat post-operative pain is limited to a single thirty-day
period and may not be extended.
(4)
The warranty
period for a purchased TENS unit is two years from the date of delivery.
(5)
Payment may be made for the rental or purchase of a used
TENS unit only if the particular unit was previously used by the individual for
whom it is currently prescribed.
(6)
Payment for a
TENS unit does not indicate or imply coverage of a conductive TENS
garment.
(7)
Payment is limited to the maximum amount for a two-lead
unit unless the provider obtains and maintains documentation in the
individual's file establishing the medical necessity of a four-lead unit.
(8)
The
medical necessity of a TENS unit not purchased by the department must be
established before payment is made for supplies or repair.
(E)
Claim
payment. The lump-sum payment for TENS supplies is twenty-five dollars.
Replaces: 5160-10-15
Notes
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5164.02
Prior Effective Dates: 04/04/1977, 12/21/1977, 12/30/1977, 01/01/1980, 03/01/1984, 05/01/1990, 06/20/1990 (Emer), 09/05/1990, 04/16/2007, 04/01/2009
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