--- title: "Refer a Patient for a TENS Unit: Documentation Guide" description: "For physicians and physical therapists: what Medicare policy L33802 says about the treating practitioner, written order, trial and supplies, plus AHC's form." url: https://analgesic.multisites.ai/guides/refer-a-patient-for-a-tens-unit publisher: Analgesic Healthcare phone: +1-800-749-1188 contact: https://analgesic.multisites.ai/contact --- ![Two clinicians review a patient record on a laptop](https://analgesic.multisites.ai/_astro/v3-pillar-refer.DI1bEJBB_Yy2j.avif) For providers # How to refer a patient for a TENS unit: documentation and process To refer a patient for a TENS unit, the ordering clinician documents the pain diagnosis, the face-to-face visit and a written order before delivery. Medicare policy L33802 adds trial monitoring and lead documentation. Analgesic Healthcare publishes a preauthorization form for doctors and physical therapists. It lists no other steps. Updated October 26, 20269 min read4 sources ## Treating practitioner orders LCD L33802 says the ordering practitioner must be the treating practitioner for the condition. ## Order before delivery Article A52520 says an item delivered before a written order is denied as not reasonable and necessary. ## Trial is monitored For chronic pain, the policy asks for a trial of one to two months, monitored by the treating practitioner. ## AHC publishes one form AHC's preauthorization form asks for the doctor or PT name, patient name, date of birth, insurance name and insurance ID. ## What does a referral for a TENS unit involve? A referral starts with the ordering clinician’s record. The record shows the diagnosis, the visit with the patient, and a written order. This page describes documentation and process only. It does not give medical advice, and it is not a legal or billing opinion. Most of the rules below come from the Medicare TENS local coverage determination, [LCD](https://analgesic.multisites.ai/glossary/local-coverage-determination) L33802, and its policy article A52520. The text applies to services performed on or after January 1, 2024. The LCD lists CGS Administrators, LLC as the DME MAC for Jurisdiction J-C, which includes Florida. Other payers set their own rules. Check each payer before you order. Step Where it comes from Treating practitioner orders LCD L33802 Face-to-face encounter Article A52520 Written order prior to delivery Article A52520 Diagnosis and coverage criteria LCD L33802 Trial monitored by the practitioner LCD L33802 Lead and supply documentation LCD L33802 For the patient’s view of the same steps, see [how to get a TENS unit](https://analgesic.multisites.ai/guides/how-to-get-a-tens-unit). For a longer provider checklist, see the [referral documentation guide](https://analgesic.multisites.ai/guides/tens-referral-documentation-guide) and the [TENS referral checklist for clinics](https://analgesic.multisites.ai/tens-referral-checklist-for-clinics). ## How do I refer a patient to Analgesic Healthcare? Analgesic Healthcare (AHC) publishes a preauthorization form for TENS units, for doctors and physical therapists. The form page says, “Fill out the form and submit it to Analgesic Healthcare.” You can find it at [the preauthorization form](https://analgesic.multisites.ai/preauthorization-form). The form asks for five items: 1. Doctor or PT name 2. Patient name 3. Patient date of birth 4. Insurance name 5. Insurance ID AHC has not published any other steps for referrals on its website. For questions about the process, call AHC at (800) 749-1188 or use [Contact](https://analgesic.multisites.ai/contact). AHC also has medical sales representatives for practices. The [providers page](https://analgesic.multisites.ai/providers) has the current details. AHC is based at 7823 N. Dale Mabry Highway, Tampa, Florida. It states that it has received accreditation from the Accreditation Commission for Health Care (ACHC). ### What patient data goes on the form? The form collects personal health information, so send only what the form asks for. Do not email a patient’s name, date of birth or insurance ID in an ordinary email. Use the form. If you are unsure, call before you send anything. ## What does the treating practitioner need to document? The LCD sets one rule about who orders. It says: “The practitioner ordering the Transcutaneous Electrical Nerve Stimulators (TENS) unit and related supplies must be the treating practitioner for the disease or condition justifying the need for the TENS unit.” So the record should show that the ordering clinician is the practitioner treating the condition. It should also show the diagnosis that the order relies on. The policy says TENS is covered “for the treatment of beneficiaries with chronic, intractable pain or acute post-operative pain when one of the following coverage criteria, I or II, are met.” Read the criteria in full in the LCD before you write the order. Our Medicare TENS guide summarizes them in plain words. A medical necessity statement should match your own exam findings, not a template. ### Which diagnoses does the policy exclude? Two exclusions matter most. The LCD says: “TENS therapy for Chronic Low Back Pain (CLBP) will be denied as not reasonable and necessary.” It also lists examples of conditions for which TENS therapy is not considered to be reasonable and necessary, including headache, visceral abdominal pain, pelvic pain and temporomandibular joint (TMJ) pain. The list is “not all-inclusive.” The LCD also says the pain “must have been present for at least three months” for chronic pain, and “Other appropriate treatment modalities must have been tried and failed.” Note these in the record if they apply. Our post on Medicare and chronic low back pain covers that exclusion. ## What do the face-to-face visit and written order require? Article A52520 says a face-to-face encounter and a written order prior to delivery apply to specified codes. The article says it “requires a face-to-face encounter and a Written Order Prior to Delivery (WOPD) for specified HCPCS codes.” Check the article for the codes that apply to your order. A [face-to-face encounter](https://analgesic.multisites.ai/glossary/face-to-face-encounter) is a visit with the patient. A [written order prior to delivery](https://analgesic.multisites.ai/glossary/written-order-prior-to-delivery) is an order that the supplier holds before it delivers the item. The article warns: “If a supplier delivers an item prior to receipt of a WOPD, it will be denied as not reasonable and necessary.” It adds: “If the WOPD is not obtained prior to delivery, payment will not be made for that item even if a WOPD is subsequently obtained by the supplier.” So send the order first. Our post on the [written order prior to delivery](https://analgesic.multisites.ai/written-order-prior-to-delivery-tens) explains this in more detail. ## What does the trial period require of the clinic? For chronic, intractable pain, the LCD requires a monitored trial. It says the unit “must be used by the beneficiary on a trial basis for a minimum of one month (30 days), but not to exceed two months.” It adds, “The trial period must be monitored by the treating practitioner to determine the effectiveness of the TENS unit in modulating the pain.” For post-operative pain, the LCD says: “Coverage is limited to 30 days (one month’s rental) from the day of surgery.” The two paths differ, so write the pain type on the order. Pain type in the LCD Rule in the LCD Chronic, intractable pain Trial of 30 days to two months, monitored by the treating practitioner Acute post-operative pain Coverage limited to 30 days from the day of surgery, rental only Plan how your clinic will record the trial: the dates, the patient’s reports, and the practitioner’s review. Our guide to the TENS trial period lists what to track, and a post explains what a 30-day trial looks like. ## What should the order say about leads and supplies? The order should state the number of leads. The LCD says: “If it is ordered for use with 4 leads, the medical record must document why 2 leads are insufficient to meet the beneficiary’s needs.” It also sets monthly limits: “2 TENS leads - a maximum of one unit of A4595 per month.” Article A52520 adds that during a rental, “supplies for the unit are included in the rental allowance; there is no additional allowance for items such as electrodes, lead wires, and batteries.” Learn more in our guides to electrode pads and supplies and [Medicare supply limits](https://analgesic.multisites.ai/medicare-tens-supply-limits). The glossary entry on electrode pads explains the parts. ## Which parts of the record do reviewers usually look at? Reviewers differ in what they check. The list below gives the items that the LCD and article name, and place each one in the chart. The table below is a plain summary of those items. It is not a full audit guide. Chart item What the source says Source Ordering clinician Must be the treating practitioner for the condition LCD L33802 Pain type Chronic, intractable pain or acute post-operative pain LCD L33802 Duration for chronic pain Present for at least three months LCD L33802 Other treatments “Other appropriate treatment modalities must have been tried and failed.” LCD L33802 Visit and order Face-to-face encounter and written order prior to delivery Article A52520 Number of leads Reason that 2 leads are insufficient, if 4 are ordered LCD L33802 Trial One to two months, monitored by the treating practitioner LCD L33802 Keep each item in the patient’s chart in a place where staff can find it. Date every entry. If a payer asks for a document, you can then send it without delay. ### What are the monthly supply limits? The LCD sets limits on the pad supply code A4595. It says: “2 TENS leads - a maximum of one unit of A4595 per month.” For four leads it says: “4 TENS leads - a maximum of two units of A4595 per month.” These limits matter when you set the number of leads on the order. Our [supply limits post](https://analgesic.multisites.ai/medicare-tens-supply-limits) gives more background. ## Which points do offices most often confuse? Four points cause the most confusion, and each has a clear rule. Check them before you write the order. 1. **Timing of the order.** The order must exist before delivery. Article A52520 says a late order does not fix a delivery made without one. 2. **Chronic low back pain.** The LCD says TENS for it “will be denied as not reasonable and necessary.” 3. **Headache.** The LCD lists it among conditions where TENS is not considered reasonable and necessary. 4. **Four leads.** A four-lead order needs a note on why two leads are not enough. If a patient’s situation does not fit these rules, say so in the record and talk with the payer. Do not promise a patient that a payer will cover a unit. Coverage depends on the plan and on your documentation. ## How can a clinic explain the process to a patient? Clear patient talk reduces calls and missed steps. Use plain words and give the patient a written summary. Keep it short. 1. Say what a TENS unit is: a device that sends mild electrical pulses through pads on the skin to relieve pain. 2. Say why you chose to try it, and what the trial will show. 3. Say that the patient needs a written order and a visit with you. 4. Tell the patient what to log each day during the trial. 5. Give the safety limits and tell the patient to follow your instructions and the device’s instructions. 6. Tell the patient who to call with problems. Our patient pages explain the same points. You can point patients to the [TENS unit safety guide](https://analgesic.multisites.ai/guides/tens-unit-safety) and the insurance coverage guide. Do not tell a patient to stop or start any medicine because of a TENS unit. That choice belongs to the patient’s prescriber. A glossary entry on [preauthorization](https://analgesic.multisites.ai/glossary/preauthorization) explains the term for staff and patients. ## What should a clinic check before sending a referral? Use a short checklist before you send the form. A complete record saves time for everyone. 1. The ordering clinician is the treating practitioner. 2. The diagnosis and pain type are in the record. 3. The face-to-face visit is documented. 4. The written order exists and names the device and the number of leads. 5. The patient’s payer and rules are known. 6. The form fields are ready: doctor or PT name, patient name, date of birth, insurance name, insurance ID. 7. The clinic has a plan to monitor the trial. Payer rules vary, and nothing on this page replaces the payer’s own policy. For Medicare Advantage, Medicaid, VA, workers’ compensation and commercial plans, check with the plan. See also the insurance coverage guide, which describes how plans differ. ## What should you tell patients about safety? Tell patients to follow your instructions and the device’s instructions. Share the safety limits and ask the patient about implanted devices before the order. The NHS says, “Do not use TENS if: you have epilepsy; you have a pacemaker; you’re pregnant, unless your doctor or midwife tells you to.” Our [TENS unit safety guide](https://analgesic.multisites.ai/guides/tens-unit-safety) lists the limits that the NHS and University of Iowa Health Care publish. The University of Iowa Health Care page also says to stop using TENS and talk with a doctor or health care team if the patient has skin irritation, headache, dizziness or nausea. Put the clinic’s phone number on the patient’s written summary so the patient knows who to call. ## Next step To send a request, use the [preauthorization form](https://analgesic.multisites.ai/preauthorization-form). For other questions about referrals, see the [providers page](https://analgesic.multisites.ai/providers) or call Analgesic Healthcare at (800) 749-1188. ## Questions people ask ### What must a physician document to order a TENS unit? For Medicare, the LCD says the ordering practitioner must be the treating practitioner for the condition. Article A52520 requires a face-to-face encounter and a written order prior to delivery for specified codes. A four-lead order needs a note on why two leads are not enough. Check your payer's own rules too. ### Can the TENS unit be delivered before the written order arrives? Under the Medicare policy article A52520, no. It says, "If a supplier delivers an item prior to receipt of a WOPD, it will be denied as not reasonable and necessary." Other payers may have other rules, so check with the payer. ### How do I send a preauthorization request to Analgesic Healthcare? AHC publishes a preauthorization form for TENS units on its website. The form asks for the doctor or PT name, the patient's name, date of birth, insurance name and insurance ID. AHC has not published other steps. Call (800) 749-1188 with questions about the process. ### What does Medicare require during the TENS trial? For chronic, intractable pain, the LCD says the unit must be used on a trial basis for at least one month, not more than two months. The treating practitioner must monitor the trial to judge the effect on pain. Rules differ for post-operative pain and for other payers. ### Does Medicare cover TENS for chronic low back pain? No. The LCD says TENS therapy for chronic low back pain will be denied as not reasonable and necessary. It also lists headache as a condition where TENS is not considered reasonable and necessary. Document the diagnosis carefully and confirm payer rules before ordering. ## Terms on this page - [Written order prior to delivery](https://analgesic.multisites.ai/glossary/written-order-prior-to-delivery) - [Local coverage determination](https://analgesic.multisites.ai/glossary/local-coverage-determination) - [Face-to-face encounter](https://analgesic.multisites.ai/glossary/face-to-face-encounter) - [Chronic low back pain](https://analgesic.multisites.ai/glossary/chronic-low-back-pain) - [Post-operative pain](https://analgesic.multisites.ai/glossary/post-operative-pain) - [Medicare Advantage](https://analgesic.multisites.ai/glossary/medicare-advantage) - [Medical necessity](https://analgesic.multisites.ai/glossary/medical-necessity) - [Preauthorization](https://analgesic.multisites.ai/glossary/preauthorization) - [Skin irritation](https://analgesic.multisites.ai/glossary/skin-irritation) - [Chronic pain](https://analgesic.multisites.ai/glossary/chronic-pain) ## Sources 1. [CMS: LCD Transcutaneous Electrical Nerve Stimulators (TENS) (L33802)](https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=33802) 2. [CMS: Article Transcutaneous Electrical Nerve Stimulators (TENS) Policy Article (A52520)](https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=52520) 3. [NHS: TENS (transcutaneous electrical nerve stimulation)](https://www.nhs.uk/conditions/transcutaneous-electrical-nerve-stimulation-tens/) 4. [Analgesic Healthcare: Preauthorization Form](https://analgesichealthcare.com/preauthorization-form/) Checked against the sources above on October 26, 2026. Coverage rules change, so check the linked page or your plan before you act. This page gives general information, not medical advice. Talk with your doctor or physical therapist about your own care, and follow your clinician's and your device's instructions. In an emergency, call 911. ## Keep reading - [Documenting a TENS referral: what the Medicare LCD and policy article requireMedicare's TENS policy (LCD L33802 and policy article A52520) asks the treating practitioner to document the pain, prior treatment, a monitored trial and the reason for any 4-lead order. A face-to-face encounter and a written order prior to delivery may also apply. This guide lists each item, quoted from the CMS documents, with no coverage promised.](https://analgesic.multisites.ai/guides/tens-referral-documentation-guide) - [A one-page TENS referral checklist for clinicsThis checklist lists what Medicare's TENS policy says the ordering practitioner and the record should show: the treating practitioner's order, the pain type and duration, prior treatments, a monitored trial, a signed order before delivery where required, and the reason for four leads. It covers documentation only.](https://analgesic.multisites.ai/tens-referral-checklist-for-clinics) - [What written order prior to delivery means for a TENS unitA written order prior to delivery (WOPD) is a signed order a supplier must hold before it delivers certain items to a Medicare patient. Under Medicare's TENS policy, an item delivered without a required WOPD is denied as not reasonable and necessary, even if the order arrives later.](https://analgesic.multisites.ai/written-order-prior-to-delivery-tens) - [How to get a TENS unit through your clinician: prescription, order, and trial stepsTo get a TENS unit through insurance, start with a visit to your clinician. Medicare requires a face-to-face visit and a written order before the supplier delivers the unit. For chronic pain, you first use the unit on a 30-day to two-month rental trial. Your clinician reviews the results. Rules differ for other plans, so check with yours.](https://analgesic.multisites.ai/guides/how-to-get-a-tens-unit) - [How many TENS supplies does Medicare allow each month?As of the LCD revision effective January 1, 2024, Medicare's usual maximum is one unit of supply code A4595 per month for a 2-lead TENS unit and two units per month for a 4-lead unit. Supplies are paid only with a covered TENS unit, and a supplier may not dispense more than a three-month quantity at a time.](https://analgesic.multisites.ai/medicare-tens-supply-limits) - [TENS unit safety: who should not use one, where pads must not go, and when to stopTENS units are not safe for everyone. The NHS says not to use TENS if you have epilepsy, have a pacemaker, or are pregnant unless your doctor or midwife tells you to. University of Iowa Health Care says not to use it with any implanted device. Never use TENS while you sleep, bathe, or drive.](https://analgesic.multisites.ai/guides/tens-unit-safety) ## Referring a patient for a TENS unit? Send the preauthorization form, or call and ask for a medical sales representative. [Send a preauthorization](https://analgesic.multisites.ai/preauthorization-form)[(800) 749-1188](tel:+1-800-749-1188)