| Clinical UM Guideline |
| Subject: Transcutaneous Electrical Nerve Stimulation | |
| Guideline #: CG-DME-04 | Publish Date: 04/16/2025 |
| Status: Revised | Last Review Date: 02/20/2025 |
| Description |
This document addresses transcutaneous electrical nerve stimulation (TENS). TENS is used to treat pain by sending electrical impulses through electrodes placed on the skin. These pulses stimulate sensory nerve fibers and are thought to modify pain perception. Other indications for TENS have also been proposed.
Note: Please see the following related documents for additional information:
Note: Over-the-counter (OTC) devices are generally excluded from benefit plan coverage.
| Clinical Indications |
Medically Necessary:
TENS units are considered medically necessary when prescribed as a treatment for pain for those who have not responded to other modalities, in the following situations:
TENS garments are considered medically necessary when:
Not Medically Necessary:
Use of TENS is considered not medically necessary when the above criteria are not met, and for all other indications.
| Coding |
The following codes for treatments and procedures applicable to this document are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.
When services may be Medically Necessary when criteria are met:
| HCPCS |
|
| A4595 | Electrical stimulator supplies, 2 lead, per month (e.g., TENS, NMES) |
| A4630 | Replacement batteries, medically necessary, transcutaneous electrical stimulator, owned by patient |
| E0720 | Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation |
| E0730 | Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation |
| E0731 | Form-fitting conductive garment for delivery of TENS or NMES (with conductive fibers separated from the patient’s skin by layers of fabric) [when specified for TENS] |
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|
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| ICD-10 Diagnosis |
|
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| All diagnoses |
When services are Not Medically Necessary:
For the procedure codes listed above when criteria are not met or for all other indications.
| Discussion/General Information |
TENS units are battery-operated devices that apply electrical stimulation through wired electrodes that are taped to the surface of the skin. TENS can also be delivered through the use of a form-fitting conductive garment (for example, a garment with conductive fibers that are separated from the individual’s skin by layers of fabric). This garment is applied when a condition exists that precludes conventional TENS electrode placement. TENS has been used to relieve pain related to musculoskeletal conditions, or pain associated with active or post-trauma injury.
There are many published reports regarding the use of TENS for various types of conditions such as low back pain (LBP), myofascial and arthritic pain, sympathetically mediated pain, neurogenic pain, visceral pain, diabetic neuropathy and postsurgical pain. While randomized controlled trials (RCTs) have focused on TENS, many of the currently available studies have methodological flaws that limit interpretation, including inadequate blinding, lack of reporting of drop outs, lack of reporting of stimulation variables, and lack of proper outcome measures (Johnson, 2015b; Ögren, 2024). However, it is recognized that TENS is widely accepted in the physician community as a treatment of a variety of etiologies of pain.
The American Society of Anesthesiologists (ASA) and American Society of Regional Anesthesia and Pain Medicine (ASRA) support the use of TENS in their revised guideline recommending that “TENS should be used as a multimodal approach to pain management for patients with chronic back pain and may be used for other pain conditions (e.g. neck and phantom limb pain)” (ASA/ASRA, 2010).
Several trials, systematic reviews, and meta-analyses have been published evaluating the use of TENS in a variety of potential indications including, but not limited to, bladder discomfort and function (Park, 2024; Tang, 2024; Zhao, 2024), diabetes (Lu, 2023), fibromyalgia (Mattar, 2025), inguinal hernia repair (Parselenes, 2021), knee osteoarthritis (Chen, 2016; Cherian, 2016; Reichenbach, 2022; Wu 2022), long covid (Zulbaran-Rojas 2024), migraine headache (Domingues, 2021; Hokenek, 2021; Tao, 2018), peripheral neuropathy (Ogle, 2020), pelvic pain (Cottrell, 2019), phantom stump pain (Johnson, 2015a), postoperative gastrointestinal recovery (Karthik 2024; Penfold, 2018), postoperative pain (Oksar, 2024; Opolka, 2024; Öztürk, 2024; Sabancı, 2024), restless leg syndrome (Şanli, 2024), rotator cuff injuries (Desmeules, 2016; Mahure, 2017), sickle cell disease (Pal, 2020), spinal cord injury (Harvey, 2016), soft tissue injuries of the elbow (Dion, 2016), temporomandibular joint pain (Busse, 2023; Fertout, 2019; Nemani, 2024, Serrano-Muñoz, 2023), wound infection (Qin, 2024), and xerostomia (Sivaramakrishnan, 2017).The results of these trials revealed weak or inconclusive support for the use of TENS for these indications.
Support for the use of TENS was found in systematic reviews conducted on its application in the treatment of dyspareunia, (Fernández‑Pérez, 2023), in-office and post hysteroscopy (De Silva, 2020; Ghamry, 2020) chronic back pain (Jauregui, 2016), dysmenorrhea (Arik, 2022; Guy, 2023), total knee arthroplasty (Li, 2017; Yue, 2018; Zhu, 2017), multiple sclerosis (Sawant, 2015), post cardiothoracic surgery (Cardinali, 2021), and limb spasticity (Mahmood, 2019; Mills, 2016).
TENS devices are generally available without a prescription (that is, over the counter [OTC]), and they are widely available at a variety of standard and online retail outlets.
| References |
Peer Reviewed Publications:
Government Agency, Medical Society and Other Authoritative Publications:
| Index |
TENS (Transcutaneous Electrical Nerve Stimulation)
Transcutaneous Electrical Nerve Stimulation (TENS)
| History |
| Status | Date | Action |
| Revised | 02/20/2025 | Medical Policy & Technology Assessment Committee (MPTAC) review. Revised title, scope, and all other content of document to remove PENS. Revised TENS garment criteria. Revised formatting in Clinical Indications section. Updated Description, Discussion/General Information, References, and Index sections. |
| Reviewed | 05/09/2024 | MPTAC review. Updated Discussion/General Information and References sections. |
| Reviewed | 05/11/2023 | MPTAC review. Updated Discussion/General Information and References sections. |
| Reviewed | 05/12/2022 | MPTAC review. Updated Discussion/General Information and References sections. |
| Revised | 05/13/2021 | MPTAC review. Clarified MN statements by removing ‘FDA approved’ language. Updated Discussion/General Information and References sections. Reformatted Coding section. |
| Reviewed | 05/14/2020 | MPTAC review. Updated Description, Discussion/General Information and References sections. |
| Reviewed | 06/06/2019 | MPTAC review. Updated Description, Discussion/General Information and References sections. |
| Revised | 07/26/2018 | MPTAC review. The document header wording updated from “Current Effective Date” to “Publish Date.” Updated Discussion/General Information and References sections. |
| Revised | 08/03/2017 | MPTAC review. Added a NMN section. Updated Discussion/General Information and References sections. |
| Reviewed | 08/04/2016 | MPTAC review. Updated Discussion/General Information and References. Removed ICD-9 codes from Coding section. |
| Revised | 08/06/2015 | MPTAC review. Revised formatting in criteria. Updated Discussion/General Information and References. |
| Reviewed | 08/14/2014 | MPTAC review. Updated Discussion/General Information and References. |
| Reviewed | 08/08/2013 | MPTAC review. Updated References. |
| Reviewed | 08/03/2012 | MPTAC review. Discussion/General Information and References updated. |
| Reviewed | 08/18/2011 | MPTAC review. Coding and References updated. |
| Reviewed | 08/19/2010 | MPTAC review. Discussion and References updated. |
| Reviewed | 08/27/2009 | MPTAC review. References updated. |
| Reviewed | 08/28/2008 | MPTAC review. References updated. |
| Reviewed | 08/23/2007 | MPTAC review. References updated. |
|
| 01/01/2007 | Updated coding section with 01/01/2007 CPT/HCPCS changes. |
| Revised | 09/14/2006 | MPTAC review. Revision included addressing TENS garment. References updated. |
|
| 11/22/2005 | Added reference for Centers for Medicare and Medicaid Services (CMS) – National Coverage Determination (NCD). |
| Revised | 09/22/2005 | MPTAC review. Revisions based on Pre-merger Anthem and Pre-merger WellPoint Harmonization. |
| Pre-Merger Organizations | Last Review Date | Document Number | Title |
| Anthem, Inc. |
| None |
|
| Anthem BCBS |
| None |
|
| WellPoint Health Networks, Inc. | 04/28/2005 | 5.10.01 | Electrical Nerve Stimulation, Transcutaneous, Percutaneous |
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