--- title: "Why Medicare does not cover TENS for chronic low back pain" description: "Medicare LCD L33802 says TENS for chronic low back pain is denied as not reasonable and necessary. See the rule, its 2012 to 2015 history and what to ask." url: https://analgesic.multisites.ai/medicare-tens-chronic-low-back-pain publisher: Analgesic Healthcare phone: +1-800-749-1188 contact: https://analgesic.multisites.ai/contact --- Coverage and paperwork # Why Medicare does not cover TENS for chronic low back pain As of the Medicare LCD revision effective January 1, 2024, TENS for chronic low back pain will be denied as not reasonable and necessary. CMS allowed coverage only inside approved clinical studies from 2012, and that window ended in June 2015. Other pain types have their own rules. Published October 26, 20264 min read6 sources ![An older woman smiles while talking on the phone](https://analgesic.multisites.ai/_astro/v2-support.D5QwD9OM_QfYy4.webp) ## Does Medicare cover a TENS unit for chronic low back pain? No. The Medicare policy for TENS units, [local coverage determination](https://analgesic.multisites.ai/glossary/local-coverage-determination) L33802, says: “TENS therapy for Chronic Low Back Pain (CLBP) will be denied as not reasonable and necessary.” This is the version with a revision effective date of January 1, 2024. The national decision, NCD 160.27, says TENS is not reasonable and necessary for treating CLBP. This post explains the rule and where it came from. It is general information, not advice about your claim. Coverage can change, so read the current policy or ask your plan. The LCD applies to Original Medicare claims handled by the DME MAC for your state. ## What does “not reasonable and necessary” mean? It means Medicare does not consider the item a covered treatment for that condition. The LCD says an item must be “reasonable and necessary for the diagnosis or treatment of illness or injury” to be covered. A denial on this ground is a [medical necessity](https://analgesic.multisites.ai/glossary/medical-necessity) denial. The reason is not a missing form. A perfect order does not change it. Our glossary defines [chronic low back pain](https://analgesic.multisites.ai/glossary/chronic-low-back-pain). The national decision says it is “an episode of low back pain that has persisted for three months or longer” and “is not a manifestation of a clearly defined and generally recognizable primary disease entity.” ## How did the rule get here? In 2012 CMS allowed a narrow exception, then let it expire. The timeline below comes from the CMS change request (transmittal R149) and the current policies. Date What CMS did Source June 8, 2012 CMS said the evidence was inadequate to support coverage as reasonable and necessary. It allowed coverage only for patients enrolled in an approved clinical study (coverage with evidence development). Transmittal R149 June 8, 2015 The change request says coverage under that study route expired. Transmittal R149 November 20, 2021 The DME MACs removed the old low back pain criterion from the LCD and added a not reasonable and necessary statement, per NCD 160.27. LCD revision history January 1, 2024 Current LCD revision. The CLBP statement remains. LCD L33802 The 2012 change request gives CMS’s reasoning in its own words: “CMS believes the evidence is inadequate to support coverage of TENS for CLBP as reasonable and necessary.” That is a statement about Medicare payment. It is not a statement about whether a TENS unit may help any one person. ## What does Medicare cover TENS for? The LCD covers TENS for two groups. The first is acute post-operative pain, limited to 30 days from the day of surgery and paid as a rental. The second is “chronic, intractable pain other than chronic low back pain” when all listed criteria are met. Those criteria include: 1. The pain must have been present for at least three months. 2. Other appropriate treatment modalities must have been tried and failed. 3. The presumed cause of the pain must be a type accepted as responding to TENS therapy. The LCD lists examples that are not considered reasonable and necessary: headache, visceral abdominal pain, pelvic pain and temporomandibular joint (TMJ) pain. So headache is also denied under this policy. See our glossary for [chronic pain](https://analgesic.multisites.ai/glossary/chronic-pain). Our guide on [whether Medicare covers a TENS unit](https://analgesic.multisites.ai/guides/does-medicare-cover-tens-unit) goes through the full rule. ## Why does this matter if your back pain is not Medicare’s concern? Many people hear that TENS “is for back pain.” Health sources do mention back pain. University of Iowa Health Care lists “Back and neck pain” among types of chronic pain TENS may be used for. Cleveland Clinic lists back pain among conditions providers use TENS to treat. Those are clinical descriptions. They do not decide Medicare payment. A unit can be recommended by a clinician and still be a denied claim under Original Medicare. A 2023 scoping review in Pain and Therapy (PMC10616008) reported that “meta-analyses reported that TENS negligibly improved symptoms of chronic back pain relative to control treatments.” The same review says more higher-quality long-term clinical trials are needed. We cite it only to show that the evidence discussion is ongoing. ## What can you do? Your clinician and your plan are the right people to ask. Do not stop or start any medicine because of this post. Talk with your doctor about your pain care as a whole. Questions to bring: 1. Is my pain chronic low back pain, or a different diagnosis with its own rules? 2. If a clinician recommends a unit, what would I owe out of pocket? 3. Does my Medicare Advantage, Medicaid, VA, workers’ compensation or commercial plan cover it? 4. Are there other treatments to try first? Plans other than Original Medicare set their own rules. University of Iowa Health Care says, “Please call your insurance company to find out if your plan covers a TENS unit.” For more on non-drug options, read our guide on [pain management without opioids](https://analgesic.multisites.ai/guides/pain-management-without-opioids). Our post on [exercises for lower back pain](https://analgesic.multisites.ai/exercises-for-lower-back-pain) covers movement approaches to discuss with your doctor. ## Next step Ask your doctor or physical therapist what applies to your type of pain, and ask your plan what it covers. For general questions about TENS units, call Analgesic Healthcare at (800) 749-1188 or use [contact](https://analgesic.multisites.ai/contact). Read our [insurance coverage guide](https://analgesic.multisites.ai/guides/tens-unit-insurance-coverage) for more. ## Questions people ask ### Does Medicare cover a TENS unit for chronic low back pain? No. As of the LCD revision effective January 1, 2024, Medicare says TENS therapy for chronic low back pain will be denied as not reasonable and necessary. National Coverage Determination 160.27 says the same. ### Did Medicare ever cover TENS for chronic low back pain? Only in a limited way. From June 8, 2012, CMS allowed coverage for chronic low back pain only for patients enrolled in an approved clinical study. The change request says that coverage expired June 8, 2015. ### What counts as chronic low back pain for Medicare? The national decision defines it as an episode of low back pain that has persisted for three months or longer and is not a manifestation of a clearly defined and generally recognizable primary disease entity. ### What about Medicare Advantage or other insurance? This post covers Original Medicare rules only. For Medicare Advantage, Medicaid, VA, workers' compensation or a commercial plan, check with your plan. University of Iowa Health Care says to call your insurance company to find out if your plan covers a TENS unit. ## Terms on this page - [Local coverage determination](https://analgesic.multisites.ai/glossary/local-coverage-determination) - [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) - [Chronic pain](https://analgesic.multisites.ai/glossary/chronic-pain) - [TENS unit](https://analgesic.multisites.ai/glossary/tens-unit) - [DME MAC](https://analgesic.multisites.ai/glossary/dme-mac) ## Sources 1. [CMS Medicare Coverage Database: LCD Transcutaneous Electrical Nerve Stimulators (TENS) (L33802)](https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=33802) 2. [CMS Medicare Coverage Database: NCD TENS for Chronic Low Back Pain (160.27)](https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?NCDId=354) 3. [CMS: Transmittal R149NCD, TENS for Chronic Low Back Pain](https://www.cms.gov/regulations-and-guidance/guidance/transmittals/downloads/r149ncd.pdf) 4. [University of Iowa Health Care: Transcutaneous electrical nerve stimulator (TENS)](https://uihc.org/health-topics/transcutaneous-electrical-nerve-stimulator-tens) 5. [Cleveland Clinic: Transcutaneous Electrical Nerve Stimulation (TENS)](https://my.clevelandclinic.org/health/treatments/15840-transcutaneous-electrical-nerve-stimulation-tens) 6. [PMC (Pain and Therapy, 2023): Do Electrical Stimulation Devices Reduce Pain and Improve Function? A Comparative Review](https://pmc.ncbi.nlm.nih.gov/articles/PMC10616008/) 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 - [Does insurance or Medicare cover a TENS unit? What the Medicare policy saysMedicare covers TENS units under its durable medical equipment benefit, but only for certain pain and only when its rules are met. As of the LCD revision effective January 1, 2024, Medicare covers chronic intractable pain and acute post-operative pain. It denies TENS for chronic low back pain. Other plans may differ, so check with your plan.](https://analgesic.multisites.ai/guides/tens-unit-insurance-coverage) - [Does Medicare cover a TENS unit? What the rules say in 2026Sometimes. Medicare's local policy (LCD L33802) covers a TENS unit for chronic, intractable pain or acute post-operative pain when set rules are met. It says TENS for chronic low back pain will be denied as not reasonable and necessary. Headache is also listed as not reasonable and necessary. Coverage is never certain.](https://analgesic.multisites.ai/guides/does-medicare-cover-tens-unit) - [TENS for lower back pain: what the evidence and Medicare coverage sayMedicare does not cover TENS for chronic low back pain. CMS decided on June 8, 2012 that the evidence was inadequate to support coverage. The current policy, LCD L33802, says it will be denied as not reasonable and necessary. A 2022 review calls the wider TENS evidence uncertain. Ask your clinician about options.](https://analgesic.multisites.ai/guides/tens-for-lower-back-pain) - [Pain management without opioids: options to discuss with your clinicianMany non-opioid options exist for pain, such as exercise, physical therapy, mind and body practices, and devices such as a TENS unit. The CDC 2022 guideline says nonopioid therapies are preferred for subacute and chronic pain. Your doctor or physical therapist decides which options fit you. Never change a medicine on your own.](https://analgesic.multisites.ai/guides/pain-management-without-opioids) - [Exercises For Lower Back PainExplore targeted exercises for lower back pain that help reduce pain and strengthen muscles. Enhance your back health with proven techniques.](https://analgesic.multisites.ai/exercises-for-lower-back-pain) - [How to get a TENS unit covered by insurance: steps and questions to askCoverage depends on your plan, your pain type and your records. Six steps help: see your treating clinician, ask your plan what it covers, get a written order, check the supplier, complete a trial, then decide on a purchase. Coverage is never certain, so confirm every step with your plan.](https://analgesic.multisites.ai/guides/get-tens-unit-covered-by-insurance) ## Questions about your unit or a bill? Call toll free. For customer care, ask for extension 508. [Call (800) 749-1188](tel:+1-800-749-1188)[Pay invoice](https://ahcpatientservices.com/)