Does Medicare Cover Tens Units?
Chronic pain has many causes, including injuries and illness. For seniors, however, the effects of aging can lead to conditions like chronic lower back pain, even in cases where no injury or disease is present. Over time and with wear, the spine and its connective tissues may experience degeneration. In addition, the supportive discs that cushion the vertebrae may become thin and offer less protection. When this occurs, nerve damage due to pressure may result in severe pain that radiates from the back down the extremities.
When you need pain relief, your doctor may suggest a range of solutions. If a TENS unit is recommended, you may be wondering if Medicare will help cover the costs.
How is chronic lower back pain treated?
Treatment for chronic lower back pain depends on the condition’s cause and severity. Over-the-counter pain relievers like Tylenol (acetaminophen) or Advil (ibuprofen) may be enough to keep pain at bay for seniors who experience mild chronic lower back pain. Prescription pain medications may also be necessary in severe cases. Additionally, physical therapy may be beneficial for seniors who are experiencing the early stages of degenerative disc disease.
Back surgery is another option for treating chronic lower back pain, but this is typically a last resort and is only considered when conservative pain management options have failed. Back and spine surgery is complex and may not be well-tolerated by seniors. In addition, underlying health conditions can further complicate the viability of surgery, leaving seniors looking for additional options.
TENS unit therapy for chronic lower back pain
Help can sometimes be found in the form of an electrostimulation device known as a TENS unit. TENS stands for transcutaneous electrical nerve stimulation. A TENS unit is an electrical device that sends pulses of electrical current to electrodes that attach to the skin around the area affected by pain. Using a TENS unit does not cause pain itself, as the current being delivered is very mild. These devices are typically powered by batteries and can be used at home or in a clinical setting. The length of time a TENS unit should be used, along with its settings, should be determined by a qualified medical professional.
How does Medicare cover TENS units?
Medicare benefits may apply toward the cost of a TENS unit, but Original Medicare does not cover TENS unit usage for chronic lower back pain. In 2012, the Centers for Medicare & Medicaid Services (CMS) issued a coverage determination that stated Medicare recipients suffering from chronic lower back pain could qualify for coverage of a TENS unit under certain circumstances. Coverage could be provided for three years from the date of the coverage determination as long as Medicare recipients were enrolled in an approved clinical study. This special coverage ended in 2015. According to CMS, there are no current approved clinical studies involving TENS.
Coverage of TENS therapy for acute post-operative pain
Despite the loss of consideration in cases of chronic lower back pain, Medicare coverage is available for TENS therapy in cases of acute post-operative pain. When Medicare benefits are available in these scenarios, the outpatient benefit of Medicare Part B supplies coverage.
Medicare Part B covers outpatient care, but it also applies to durable medical equipment (DME) purchases and rentals. To qualify for coverage, DME must be obtained from a Medicare-approved supplier. Medicare benefits cover 80% of the cost of purchasing or renting a TENS unit when such therapy is prescribed as medically necessary.
A TENS unit may also be used in an inpatient setting like a hospital or skilled nursing facility (SNF). In such cases, Medicare Part A may supply coverage instead. Medicare Part A is inpatient coverage that provides benefits for up to 60 days in a hospital or 20 days in an SNF. After your allotted days have been used within a benefit period, you may qualify for additional days by paying a discounted per-day rate.