Proper Billing for Supplies for Transcutaneous Electrical Nerve Stimulation Units

August 2024

Proper Billing for Supplies for Transcutaneous Electrical Nerve Stimulation Units

Incorrect coding on claims for Transcutaneous Electrical Nerve Stimulation Units and necessary supplies causes additional costs for you and our members. Here are some tips to help ensure proper billing for medically necessary care and services.

TENS Unit Rental
One month of necessary supplies are included in the rental of a TENS unit. There’s no need to order additional items such as electrodes, lead wires and batteries for the first month of use.

Trial Before Purchase
Our Medical Policy MED201.040 recommends a trial use of a TENS unit used daily or near daily for at least 30 days to establish efficacy of the treatment and compliance. The trial must be monitored by an appropriate provider. The ordering provider must deem the trial period successful, prior to ordering and dispensing a purchased TENS unit. Refer to the Medical Policies section of our website to view MED201.040 in detail.

TENS Unit Purchase
A purchased TENS unit includes lead wires, which usually last one year, and one month of necessary supplies including all electrodes, conductive paste or gel (if needed) and batteries.

Appropriate Coding
For the TENS unit purchase or rental, use Healthcare Common Procedure Coding System code E0720 or E0730 with applicable modifiers.

For additional supplies after the first month of use, use HCPCS code A4595. It includes all required electrodes and items such as conductive paste or gel, tape or other adhesive, adhesive remover, skin preparation materials, batteries and a battery charger.

Units To Be Billed for Supplies
A4595 – Replacement supplies:

2 Leads/1 unit per month
4 Leads/2 units per month

A4557 – Replacement lead wires:

Lead wires – 2 electrode system/1 unit per year
Lead wires – 4 electrode system/2 units per year

The following codes are not valid for claim submission for the TENS durable medical equipment benefit:

A4556 [Electrodes (e.g., apnea monitor), per pair]
A4558 (Conductive paste or gel)
A4630 (Replacement batteries for a medically necessary patient-owned TENS unit)

Prescription Requirements
A prescription or order must be available if requested for DME rentals or purchase. The prescription or order must be signed by the member’s treating, qualified health care provider. When a qualified health care provider completes and signs the prescription or order, they are attesting that the information indicated on the form is correct and that the requested services are necessary and appropriate. The provider’s prescription or order must be renewed annually.

For more information on what a prescription or order should include for a TENS rental or purchase, refer to our Clinical Payment and Coding Policies page to view Physical Medicine and Rehabilitation Services CPCP040.

The prescription or order for DME should include:

Member’s name and date of birth
Diagnosis
Type of equipment/supplies
Provider’s rationale
Date of prescription/order
Date and duration of expected use
Quantity (if applicable)
Provider name, address and phone number
Legible provider signature and date

The Medical Policies at Blue Cross and Blue Shield of Illinois are for informational purposes only and are not a substitute for the independent medical judgment of health care providers. Providers are instructed to exercise their own clinical judgment based on each individual patient’s health care needs. The fact that a service or treatment is described in a medical policy is not a guarantee that the service or treatment is a covered benefit under a health benefit plan. Some benefit plans administered by BCBSIL, such as some self-funded employer plans or governmental plans, may not utilize our medical policies. Members should contact the customer service number on their member ID card for more specific coverage information. Although medical policies can be used as a guide, providers serving HMO members should refer to the HMO Scope of Benefits.

BLUE REVIEW^SM

for Providers