Tough News for TENS Units
For many years health plans, both workers’ compensation and group medical, have spent considerable resources on TENS units (Transcutaneous Electrical Nerve Stimulation). It would appear that a ruling issued August 1, 2012 by Centers for Medicare and Medicaid Services will substantially change that.
Effective June 8, 2012 workers’ compensation cases not yet settled may NOT include in the Medicare Set Aside the costs of TENS units when prescribed for chronic low back pain (CLBP). It further states that claimants may not use funds from their MSA to pay for non-covered TENS for CLBP.
Relying on mountains of evidence refuting the efficacy of TENS treatment for CLBP, CMS has removed them from the equation. And this means they will eventually be removed from other equations as well. Historically, CMS decisions regarding appropriate healthcare filter down to commercial insurance carriers. Those carriers most often quickly adopt CMS guidelines. That means in this case you can expect to see carriers to begin denying TENS for CLBP. How soon that impacts workers compensation depends more upon individual states but it’s a sure bet that eventually TENS is gone for CLBP in those cases as well. TENS is still an accepted treatment for acute LBP.
At OMCA, we have successfully helped our clients dispute and deny requests for TENS for many years. Using scientific evidence, our physician advisors have made the case that TENS is not a panacea for most CLBP diagnoses. Now, even CMS agrees with us.
Call us, We can do better.