What It Is
An outpatient medical device to reduce acute postoperative or unmanageable chronic pain
Medicare Part B and Medicare Part C plans cover rental, and in some cases purchase, of a TENS device prescribed by a physician, but only under limited circumstances. The coverage rules differ depending on whether the patient is suffering acute postoperative pain or chronic pain.
Acute post-operative pain. Medicare Part B covers the rental, for up to 30 days, of a TENS device for a patient in acute pain immediately following a surgical procedure. Coverage can be extended for rental beyond the initial 30 days in exceptional circumstances, as documented by the physician.
Chronic pain. Medicare Part B may cover a TENS unit for a patient who has been suffering from chronic pain for at least three months, for which other, standard pain relief methods have failed. The pain must be of the type that typically responds to TENS; this does not include headache, internal abdominal pain, or temporomandibular (TMJ) pain in the jaw or face.
A qualifying chronic pain patient initially rents a TENS device for 30 to 60 days, after which the treating physician must certify that the device is likely to provide the patient with significant long-term pain relief. If the device is so certified, Medicare Part B will cover purchase of the TENS device.
If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. To find out whether your Medicare Part C plan has expanded coverage for a TENS device, contact the plan directly.
What Medicare Pays
Medicare Part B pays 80 percent of the Medicare-approved amount for the rental or purchase of a covered TENS device.
Under a Medicare Part C plan, co-payments for a TENS device may be different than under Medicare Part B. To find out what the copayments are for a TENS device under your Medicare Part C plan, contact the plan directly.
Warning: If covered equipment is rented or purchased under Medicare Part B from what's called a Medicare "participating supplier," the supplier can't charge more than the Medicare-approved amount for the item. However, a supplier who's enrolled in Medicare but isn't an officially "participating" supplier may charge more than the Medicare-approved amount. In that case, the patient must personally pay the difference between the Medicare-approved amount and the amount the supplier actually charges (on top of the 20 percent of the Medicare-approved amount that Medicare Part B doesn't pay).
Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:
The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?
The care must be performed or delivered by a healthcare provider who participates in Medicare.