--- title: "A one-page TENS referral checklist for clinics | Analgesic Healthcare" description: "A documentation checklist for clinics ordering TENS units for Medicare patients, built from LCD L33802, policy article A52520 and NCD 160.7.1." url: https://analgesic.multisites.ai/tens-referral-checklist-for-clinics publisher: Analgesic Healthcare phone: +1-800-749-1188 contact: https://analgesic.multisites.ai/contact --- Coverage and paperwork # A one-page TENS referral checklist for clinics This 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. Published October 26, 20264 min read3 sources ![A clinic receptionist holds a tablet at the front desk](https://analgesic.multisites.ai/_astro/v3-post-clinic-checklist.fGLee4pB_hQV8q.webp) ## What does a TENS referral need to show? Under Medicare’s TENS policy, the record needs to show a treating practitioner’s order, a qualifying pain type and duration, prior treatments, and a monitored trial. This post lists those items in one table. It describes documentation only, taken from the policy text as of the LCD revision effective January 1, 2024. It is not legal or billing advice. Check the current policy and your Medicare contractor. A TENS unit sends mild electrical pulses through pads on the skin to relieve pain. The rules differ for plans other than Original Medicare, so check with the plan. ## What is on the one-page checklist? # Item to document What the policy says Source 1 Treating practitioner The ordering practitioner “must be the treating practitioner for the disease or condition justifying the need for the TENS unit.” LCD L33802 2 Pain type Covered for chronic, intractable pain or acute post-operative pain when criteria are met. Acute post-operative: 30 days from surgery, rental only. LCD L33802 3 Pain duration For chronic pain, “The pain must have been present for at least three months.” LCD L33802 4 Prior treatment “Other appropriate treatment modalities must have been tried and failed.” LCD L33802 5 Cause of pain The presumed cause “must be a type that is accepted as responding to TENS therapy.” LCD L33802 6 Trial plan Minimum one month (30 days), not over two months, paid as a rental, monitored by the treating practitioner. LCD L33802; NCD 160.7.1 7 Purchase determination For a purchase, the treating practitioner makes the determination the LCD describes about continuous use of the unit over a long period of time. LCD L33802 8 Number of leads If ordered for 4 leads, the record must document why 2 leads are insufficient. LCD L33802 9 Standard Written Order Must reach the supplier before a claim is submitted. LCD L33802 10 Written order prior to delivery Where required, the signed order must be received before delivery. LCD L33802; Article A52520 11 Face-to-face encounter Required with a WOPD for “specified HCPCS codes” under Final Rule 1713. Article A52520 Row 7 is listed because the LCD makes this practitioner determination a condition for coverage of a purchase. ## Which pain types are not covered? Document the diagnosis clearly, because some are denied. The LCD says: “TENS therapy for Chronic Low Back Pain (CLBP) will be denied as not reasonable and necessary.” It lists headache, visceral abdominal pain, pelvic pain and temporomandibular joint (TMJ) pain as examples of conditions for which TENS “is not considered to be reasonable and necessary.” It also says TENS “will be denied as not reasonable and necessary for acute pain (less than three months duration) other than for post-operative pain.” For the history of the low back pain rule, read [why Medicare does not cover TENS for chronic low back pain](https://analgesic.multisites.ai/medicare-tens-chronic-low-back-pain). A local coverage determination is a regional Medicare policy that sets when an item is covered. [Medical necessity](https://analgesic.multisites.ai/glossary/medical-necessity) is the term payers use for whether an item is reasonable and needed. ## How does the order timing work? A [written order prior to delivery](https://analgesic.multisites.ai/glossary/written-order-prior-to-delivery) is a signed order the supplier must hold before delivering certain items. Article A52520 says: “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.” A [face-to-face encounter](https://analgesic.multisites.ai/glossary/face-to-face-encounter) is a visit in which a practitioner evaluates the patient before ordering certain equipment. Ask your supplier or the DME MAC which TENS items are on the “specified HCPCS codes” list. Our post on [what written order prior to delivery means](https://analgesic.multisites.ai/written-order-prior-to-delivery-tens) goes through the wording. ## What documents are no longer needed? Article A52520 says “Providers and suppliers no longer need to submit Certificate of Medical Necessity (CMN) for services rendered on or after January 1, 2023.” It adds that claims received with those forms attached will be rejected and returned. It also says “A CMN is not needed for a TENS rental.” ## What about the trial and supplies? During a rental, the article says supplies “are included in the rental allowance.” After a purchase, the LCD sets usual maximums for supply code A4595, and suppliers verify unusual use with the treating practitioner. The trial rule is above. ## What safety screening can the record note? This part is our suggestion, not a CMS requirement. The NHS says not to use TENS if you have epilepsy or a pacemaker, or are pregnant unless your doctor or midwife says so. University of Iowa Health Care lists a cardiac pacemaker or defibrillator, a spinal cord stimulator and any implanted metallic or electronic device. A record note that the screening questions were asked is one way to show the check was made. Our [TENS unit safety guide](https://analgesic.multisites.ai/guides/tens-unit-safety) lists them. ## Where can clinics read more? Our guide on [TENS referral documentation](https://analgesic.multisites.ai/guides/tens-referral-documentation-guide) covers the paperwork in detail. The pillar guide on [how to refer a patient for a TENS unit](https://analgesic.multisites.ai/guides/refer-a-patient-for-a-tens-unit) covers the process from first visit to follow-up. ## Next step Analgesic Healthcare offers a [preauthorization form](https://analgesic.multisites.ai/preauthorization-form) for TENS units for doctors and physical therapists. The company also has medical sales representatives for practices. See the [providers page](https://analgesic.multisites.ai/providers). ## Questions people ask ### Who must order a TENS unit for a Medicare patient? The LCD says the practitioner ordering the TENS unit and related supplies must be the treating practitioner for the disease or condition justifying the need for the TENS unit. ### What must the medical record show? The LCD says it is expected that the beneficiary's medical records will reflect the need for the care provided. For a 4-lead order, it says the medical record must document why 2 leads are insufficient to meet the beneficiary's needs. ### Does the order have to come before delivery? A Standard Written Order must reach the supplier before a claim is submitted. For items that require a written order prior to delivery, the supplier must hold the signed order before delivering the item, or the claim is denied as not reasonable and necessary. ## 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) - [Cardiac pacemaker](https://analgesic.multisites.ai/glossary/cardiac-pacemaker) - [Medical necessity](https://analgesic.multisites.ai/glossary/medical-necessity) - [Preauthorization](https://analgesic.multisites.ai/glossary/preauthorization) - [Chronic pain](https://analgesic.multisites.ai/glossary/chronic-pain) - [Acute pain](https://analgesic.multisites.ai/glossary/acute-pain) ## 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: Article Transcutaneous Electrical Nerve Stimulators (TENS) - Policy Article (A52520)](https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=52520) 3. [CMS Medicare Coverage Database: NCD Assessing Patient's Suitability for Electrical Nerve Stimulation Therapy (160.7.1)](https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?NCDId=63) 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) - [How to refer a patient for a TENS unit: documentation and processTo 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.](https://analgesic.multisites.ai/guides/refer-a-patient-for-a-tens-unit) - [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) - [Why Medicare does not cover TENS for chronic low back painAs 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.](https://analgesic.multisites.ai/medicare-tens-chronic-low-back-pain) - [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) - [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) ## 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)