Does E0731 require prior authorization?

Yes, E0731 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

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`E0731`, Form fitting conductive garment for delivery of tens or nmes (with conductive

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.

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).

13 Active Policies

ANTHEM-CG-DME-03, Neuromuscular Stimulation in the Treatment of Muscle Atrophy

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)

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

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

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

`E0731`, Form fitting conductive garment for delivery of tens or nmes (with conductive

Prior Authorization

Documentation Required

Key Coverage Criteria

13 Active Policies

Related Codes

Have a follow-up question?

E0731, Form fitting conductive garment for delivery of tens or nmes (with conductive

Prior Authorization

Documentation Required

Key Coverage Criteria

13 Active Policies

Related Codes

Have a follow-up question?

`E0731`, Form fitting conductive garment for delivery of tens or nmes (with conductive