About this policy
CMS National Coverage Determination | ncd_id=151 | manual_section=160.13 | coverage_level_code=2 | national_coverage_type=True | under_review=False | lab_ncd=False
Coverage indications
A form-fitting conductive garment (and medically necessary related supplies) may be covered under the program only when: 1. It has received permission or approval for marketing by the Food and Drug Administration; 2. It has been prescribed by a physician for use in delivering covered TENS or NMES treatment; and 3. One of the medical indications outlined below is met: The patient cannot manage without the conductive garment because there is such a large area or so many sites to be stimulated and the stimulation would have to be delivered so frequently that it is not feasible to use conventional electrodes, adhesive tapes and lead wires; The patient cannot manage without the conductive garment for the treatment of chronic intractable pain because the areas or sites to be stimulated are inaccessible with the use of conventional electrodes, adhesive tapes and lead wires; The patient has a documented medical condition such as skin problems that preclude the application of conventional electrodes, adhesive tapes and lead wires; The patient requires electrical stimulation beneath a cast either to treat disuse atrophy, where the nerve supply to the muscle is intact, or to treat chronic intractable pain; or The patient has a medical need for rehabilitation strengthening (pursuant to a written plan of rehabilitation) following an injury where the nerve supply to the muscle is intact. A conductive garment is not covered for use with a TENS device during the trial period specified in §160.3 unless: 4. The patient has a documented skin problem prior to the start of the trial period; and 5. The B/Medicare Administrative Contractorâs medical consultants are satisfied that use of such an item is medically necessary for the patient. (See conditions for coverage of the use of TENS in the diagnosis and treatment of chronic intractable pain in §§160.3, 160.13 , and 160.27 , and the use of NMES in the treatment of disuse atrophy in §150.4.)
Documentation requirements
Item/Service Description: Transcutaneous Electrical Nerve Stimulation (TENS) and/or Neuromuscular Electrical Stimulation (NMES) can ordinarily be delivered to patients through the use of conventional electrodes, adhesive tapes and lead wires. There may be times, however, where it might be medically necessary for certain patients receiving TENS or NMES treatment to use, as an alternative to conventional electrodes, adhesive tapes and lead wires, a form-fitting conductive garment (i.e., a garment with conductive fibers which are separated from the patientsâ skin by layers of fabric). Cross Reference: Also see NCDs on NMES in the Treatment of Disuse Atrophy (§150.4), Assessing Patients Suitability for ENS (§ 160.7 ), NMES (§ 160.12 ), and TENS (§ 280.13 ). Revision History: 07/1995 - Specified that TENS covered under durable medical equipment benefit rather than prosthetic device benefit. Effective date 08/07/1995. (TN 78) 06/1988 - Established conditions under which supplies may be covered. Effective date 07/14/1988. (TN 26) Benefit Categories: 33 - Incident to a physician's professional Service Transmittal: transmittal_number=78 | transmittal_issue_date=1995-07-01
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
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