Medicare Drops TENS Coverage for Low Back Pain

A federal agency has issued a final ruling that Medicare will no longer cover transcutaneous electrical nerve stimulation (TENS) for chronic low back pain. The ruling takes effect immediately.

“TENS is not reasonable and necessary for the treatment of [chronic low back pain],” the Centers for Medicare and Medicaid Services (CMS) said in a decision memo.

TENS units are small, battery operated devices that apply an electrical current to the skin for pain relief. Medicare has been paying for TENS equipment and supplies when prescribed by a doctor for chronic pain, and it has reimbursed physicians and physical therapists for evaluating patients for TENS.

Medicare will continue to reimburse for TENS when it’s prescribed for chronic pain other than lower back pain, such as cancer pain or post-operative pain. Reimbursement for TENS treatment of low back pain will only be available if a patient is participating in a randomized, controlled trial of TENS’ effectiveness.

A TENS unit

CMS began its reveiw of coverage of TENS for low back pain after an American Academy of Neurology panel found the treatment was not effective. The panel found “conflicting evidence for the use of TENS in the treatment of chronic low back pain and that TENS should be deemed ineffective for this purpose.”

CMS began accepting public comments on its proposal to drop coverage last September. It also met with TENS manufacturer and researchers, who urged that TENS coverage should continue.

“Neither the comments we received, nor the discussions that we have had with industry and investigators have provided us with the persuasive scientific evidence to reach a different conclusion,” the CMS memo said.

“Although we disagree with their conclusions, we understand Medicare’s financial decisions are difficult as they strive to manage our national health care expenditures,” said Karl Kuzis, MD, vice president of Medical and Clinical Affairs for RS Medical, a company that sells electrotherapy devices. “Pain treatment specialists face many challenges from reimbursement, regulatory and economic pressures.”

When asked for comments earlier this year on Medicare coverage of TENS for chronic low back pain, the American Society of Anesthesiologists and the American Academy of Pain Medicine (AAPM) recommended continued TENS coverage.

“There are few pharmacological or interventional treatments that offer the potential of pain relief with associated improvement in function for the relatively low cost and minimal short and long-term risks associated with the use of TENS,” the AAPM said in a statement. “At a time when so much attention is being paid to safe prescribing, with all the attendant problems of excessive or misused pharmacotherapy, it would be catastrophic to eliminate such a safe and, for selected patients, potentially effective therapy.”

Low back pain is the fifth most common medical problems for which people seek treatment. Up to 80 percent of Americans will have an episode of low back pain at some point in their lives, according to CMS. For most, low-back pain is a short-lived condition, but for some it can turn into a chronic, disabling condition.

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