Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-10 - Medical Supplies, Durable Medical Equipment, Orthoses, and Prosthesis Providers
Section 5160-10-15 - DMEPOS: transcutaneous electrical nerve stimulation (TENS) units
Universal Citation: OH Admin Code 5160-10-15
Current through all regulations passed and filed through September 16, 2024
(A) Definitions.
(1) "Accessories" is a collective term that
encompasses but is not necessarily limited to the following items:
(a) Adapters;
(b) Clips;
(c) Additional connecting cable for lead
wires;
(d) Carrying pouches;
and
(e) Covers.
(2) "Supplies" is a collective
term that encompasses but is not necessarily limited to the following items:
(a) Electrodes of any type;
(b) Lead wires;
(c) Conductive paste or gel;
(d) Adhesive;
(e) Adhesive remover;
(f) Skin preparation materials;
(g) Batteries; and
(h) Battery charger for rechargeable
batteries.
Provider requirement. A provider of transcutaneous electrical nerve stimulation (TENS)
(B) Coverage.
(1) Payment may be made for a TENS unit on a
rental/purchase basis.
(2) The
default certificate of medical necessity (CMN) form is the ODM 03402,
"Certificate of Medical Necessity: Transcutaneous Electrical Nerve Stimulation
(TENS) Units" (rev. 7/2018). The CMN
includes one of the following
statements of need:
(a) For neurogenic pain,
the following information:
(i) An attestation
that the individual is experiencing intractable, nerve-related pain that has
lasted at least six months;
(ii) An
appropriate supporting diagnosis; and
(iii) An attestation that the use of a
comparable TENS unit for a trial period of at least thirty days produced
substantial relief from pain and, if applicable, enabled a significant
reduction in medication (e.g., muscle relaxants, narcotics, analgesics);
or
(b) For post-operative
pain, the following information:
(i) An
attestation that treatment lasting no longer than thirty days is needed for
acute pain following surgery; and
(ii) The date of
surgery.
(3)
Rental of a TENS unit to treat neurogenic pain is
limited to four months.
(4)
Rental of a TENS unit to treat post-operative pain is
limited to a single thirty-day period and may not be extended.
(5)
Payment may be made for the purchase of a TENS unit to
treat neurogenic pain, either after a rental period or without a rental
period, if the prescriber attests to the medical necessity of continued
treatment.
(6)
Separate payment may be made
for repair of or supplies for a TENS unit owned by an individual. If the unit
was not purchased through medicaid, such payment may be made only if the
medical necessity of the unit has been established beforehand.
Supplies are
to be dispensed only when they are needed, at a frequency not to exceed
once per month. The payment made for supplies is an all-inclusive lump sum and
does not depend on the number or nature of items in a particular shipment. No
separate payment is allowed for individual supply items.
(7)
After a TENS unit has been purchased, no separate payment is allowed for
accessories.
(C) Constraints and limitations.
(1) A diagnosis of "chronic intractable pain"
is not in itself sufficient to warrant coverage.
(2) The warranty period
for a purchased TENS unit is two years from the date of delivery.
(3)
Payment may be made for the rental or purchase of a used TENS unit only if the
particular unit was previously used by the individual for whom it is currently
prescribed.
(4) Payment for a TENS
unit does not indicate or imply coverage of a conductive TENS
garment.
(5) Payment is limited
to the maximum amount for a two-lead unit unless the provider obtains and
maintains documentation in the individual's file establishing the medical
necessity of a four-lead unit.
(D) Claim payment. The lump-sum payment for TENS supplies is twenty-five dollars.
Disclaimer: These regulations may not be the most recent version. Ohio may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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