Update on Medicare Proposed TENS Coverage Decision for Chronic Low Back Pain Treatment

Press Release from APTA:

Update on Medicare Proposed TENS Coverage Decision for Chronic Low Back Pain Treatment

The Centers for Medicare and Medicaid Services will soon issue a final ruling on its National Coverage Analysis Proposed Decision Memo regarding transcutaneous electrical nerve stimulation (TENS) for chronic low back pain (CLBP) on June 11.  Within the memo – issued on March 13, 2012 – CMS proposed to limit Medicare coverage of TENS for CLBP to patients who enroll in an approved prospective clinical study.  The clinical study must address whether TENS provides a clinically meaningful reduction in pain, improvement in function, or reduction in other treatments or services.  In addition, the study must adhere to specified standards of scientific integrity and relevance to the Medicare population.  A summary of the proposed decision memo is available to APTA members on the Medicare Coverage Issues webpage under the “TENS” heading.

APTA submitted comments regarding the proposed decision on April 12, 2012, expressing its concern that this requirement to enroll in a clinical study is highly burdensome for the Medicare beneficiary and will severely limit patient access to medically necessary treatment utilized to improve overall function and health.

As the June 11 final decision date approaches, advocacy continues through Congressional and grassroots efforts outside of APTA. Congressional members, such as Rep. Darrell Issa, Chairman of the House Committee on Oversight and Government Reform, have also weighed in on this coverage issue.  For example, in a letter dated May 3, Congressman Issa wrote that “TENS has long been recognized by CMS as an effective treatment for Medicare beneficiaries with low back pain and its costs have long been covered by Medicare.”  Issa asked CMS to provide him with information explaining the rationale behind its decision.

Grassroots advocacy for TENS coverage is also taking place through a website petition hosted by DJO Global.  Nearly 8,000 patients and clinicians have signed the petition protesting the proposed coverage decision.

For more information regarding APTA’s advocacy efforts on this issue as well as the advocacy occurring outside of our association, please feel free to contact us at advocacy@apta.org.

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