CMS Analysis of Transcutaneous Electrical Nerve Stimulation (TENS) Outcomes
Update: On June 8, 2012, CMS released a final decision memorandum on coverage for Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Low Back Pain. CMS ruled that TENS is not reasonable and necessary for the treatment of Chronic Low Back Pain under Social Security Act §1862(a)(1)(A), and will be covered (subject to certain criteria) only to support additional research and evidence development.
The Therapeutic and Technology Assessment Subcommittee of the American Academy of Neurology (AAN) published a report in 2010 finding transcutaneous electrical nerve stimulation (TENS) ineffective for chronic low back pain. TENS units are usually small, portable, battery-operated devices that apply an electrical current to the skin to relieve pain. Stimulation parameters such as pulse width, pulse frequency, wave pattern, frequency, and intensity are varied in both clinical usage and the research literature. These parameters are often determined for individual patients by a trial-and-error method that requires several sessions of skilled therapy.
Due to this report, the Centers for Medicare & Medicaid Services (CMS) is conducting a national coverage analysis on the use of TENS for the treatment of chronic low back pain. This analysis consists of reviewing evidence relating to the health outcomes attributable to the use of TENS in home settings, and clinical studies falling under the Coverage with Evidence Development paradigm. CMS is conducting this analysis to see if a national coverage determination (NCD) is warranted for TENS under Social Security Act sections 1862(a)(1)(A) and 1862(a)(1)(E).
CMS intends to complete its NCA by June 2012, and an NCD (if any) will be released by March 2012.
The impact of this NCA on occupational therapists—particularly hand therapists—will be determined by the specific language of any resulting NCD. AOTA will continue to follow this matter and review NCDs as they are issued by CMS. Please e-mail rrpd@aota.org with any questions or concerns.
