Does E0720 require prior authorization?

Yes, E0720 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

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`E0720`, Transcutaneous electrical nerve stimulation (tens) device, two lead, localized

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

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.
For purchases after a trial, the treating practitioner must document that the beneficiary is likely to derive significant therapeutic benefit from continuous long-term use.
If a 4-lead unit is ordered for 4-lead use, the medical record must document why 2 leads are insufficient to meet the beneficiary's needs.
Proof of delivery (POD) documentation must be maintained by the supplier and made available upon request.
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

EVICORE-HPLAN-CIGNA_MEDICARE-268F28B96146, Cigna Medicare Advantage Durable Medical Equipment Code List - Effective 01/01/2025

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

L33802, Transcutaneous Electrical Nerve Stimulators (TENS)

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

AETNA-CPB-0673, Knee Arthroscopy / Osteoarthritis of the Knee

AETNA-CPB-0625, Dysphagia Therapy

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

AETNA-CPB-0707, Headaches: Invasive Procedures

AETNA-CPB-0431, Enuresis

AETNA-CPB-0004, Obstructive Sleep Apnea in Adults

AETNA-CPB-0725, Post-Herpetic Neuralgia

AETNA-CPB-0362, Spasticity Management

AETNA-CPB-0028, Temporomandibular Disorders

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

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

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

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

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E0720, Transcutaneous electrical nerve stimulation (tens) device, two lead, localized

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

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.
For purchases after a trial, the treating practitioner must document that the beneficiary is likely to derive significant therapeutic benefit from continuous long-term use.
If a 4-lead unit is ordered for 4-lead use, the medical record must document why 2 leads are insufficient to meet the beneficiary's needs.
Proof of delivery (POD) documentation must be maintained by the supplier and made available upon request.
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

EVICORE-HPLAN-CIGNA_MEDICARE-268F28B96146, Cigna Medicare Advantage Durable Medical Equipment Code List - Effective 01/01/2025

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

L33802, Transcutaneous Electrical Nerve Stimulators (TENS)

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

AETNA-CPB-0673, Knee Arthroscopy / Osteoarthritis of the Knee

AETNA-CPB-0625, Dysphagia Therapy

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

AETNA-CPB-0707, Headaches: Invasive Procedures

AETNA-CPB-0431, Enuresis

AETNA-CPB-0004, Obstructive Sleep Apnea in Adults

AETNA-CPB-0725, Post-Herpetic Neuralgia

AETNA-CPB-0362, Spasticity Management

AETNA-CPB-0028, Temporomandibular Disorders

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

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

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

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

Have a follow-up question?

Ask Backwork about documentation requirements, denial risks, or coverage in your state.

Ask Backwork about E0720 Sign up free

`E0720`, Transcutaneous electrical nerve stimulation (tens) device, two lead, localized

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`E0720`, Transcutaneous electrical nerve stimulation (tens) device, two lead, localized

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

E0720, Transcutaneous electrical nerve stimulation (tens) device, two lead, localized

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

E0720, Transcutaneous electrical nerve stimulation (tens) device, two lead, localized

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`E0720`, Transcutaneous electrical nerve stimulation (tens) device, two lead, localized

`E0720`, Transcutaneous electrical nerve stimulation (tens) device, two lead, localized