Does A4595 require prior authorization?

Yes, A4595 requires prior authorization (medium confidence). Conditional coverage; review criteria to confirm PA need.

What is the Medicare reimbursement rate for A4595?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`A4595`, Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes)

HCPCS/CPT

Prior Authorization

Prior Auth Required

Conditional coverage; review criteria to confirm PA need (medium confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

The practitioner ordering the TENS unit and supplies must be the treating practitioner for the disease/condition justifying the need and must monitor the trial period.
A Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted; for DMEPOS base items requiring WOPD, the supplier must have a signed WOPD before delivery.

Suppliers must contact the beneficiary and document an affirmative response prior to dispensing refills; contact must occur no sooner than 30 days before expected end of supply and delivery no sooner than 10 days before expected end.

Key Coverage Criteria

A TENS unit is covered when ordered by the treating practitioner for treatment of acute post-operative pain, with coverage as a rental beginning the day of surgery.
A TENS unit is covered for chronic, intractable pain other than chronic low back pain when the presumed etiology is one accepted to respond to TENS therapy.
Coverage for chronic pain requires pain duration of at least 3 months.
Coverage for chronic pain requires that other appropriate treatment modalities have been tried and failed prior to ordering TENS.
A 4-lead TENS may be used when clinically indicated; if ordered for 4-lead use, the medical record must document why 2 leads are insufficient.
Replacement supplies are covered when reasonable and necessary and used with a covered TENS unit (reimbursement contingent on a covered TENS).

20 Active Policies

ANTHEM-CG-DME-04, Transcutaneous Electrical Nerve Stimulation

CIGNA-0160, Electrical Stimulation Therapy and Devices in a Home Setting

L33802, Transcutaneous Electrical Nerve Stimulators (TENS)

L34821, Transcutaneous Electrical Joint Stimulation Devices (TEJSD)

UHC-POL-electrical-stimulation-treatment-pain-muscle-rehabilitation, Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation

AETNA-CPB-0011, Peripheral Electrical Nerve Stimulation for Pain

AETNA-CPB-0707, Headaches: Invasive Procedures

AETNA-CPB-0725, Post-Herpetic Neuralgia

AETNA-CPB-0362, Spasticity Management

AETNA-CPB-0406, Tinnitus Treatments

AETNA-CPB-0469, Transcranial Magnetic Stimulation and Cranial Electrical Stimulation

BCBSIL-MED201.027, Electrostimulation and Electromagnetic Therapy for Treating Wounds

BCBSIL-MED205.042, Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions

BCBSMT-MED201.027, Electrostimulation and Electromagnetic Therapy for Treating Wounds

BCBSMT-MED205.042, Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions

BCBSNM-MED201.027, Electrostimulation and Electromagnetic Therapy for Treating Wounds

BCBSNM-MED205.042, Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions

BCBSOK-MED201.027, Electrostimulation and Electromagnetic Therapy for Treating Wounds

BCBSOK-MED205.042, Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions

UMR-POL-UMR-electrical-stimulation-treatment-pain-muscle-rehabilitation, Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation

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A4595, Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes)