Telemedicine services are a covered benefit. More>>
The use of secure interactive audio/video technology may be used to provide clinical consultations and office visits when appropriate and medically necessary. This includes:
- Office or other outpatient visits
- End stage renal disease (ESRD)-related services
- Individual psychotherapy
- Psychiatric diagnostic evaluations
- Pharmacologic management
See also telemedicine services.
Temporalmandibular Joint Syndrome Treatment
Treatment of temporalmandibular joint (TMJ) syndrome is a limited benefit. More >>
Transcranial Magnetic Stimulation (TMS)
Transcranial magnetic stimulation (TMS) is a limited benefit for beneficiaries age 18 and older with major depression. Prior authorization is required.
To expedite the review process, providers may attach a Letter of Attestation in lieu of clinical documentation to the authorization request.
Transcutaneous Electrical Nerve Stimulation (TENS)
Transcutaneous electrical nerve stimulation (TENS) is covered in limited circumstances. TENS for the treatment of acute, subacute and chronic low back pain is not a covered benefit. In addition to the device, supplies for TENS units prescribed for low back pain, physical therapy visits where the sole treatment provided is TENS for low back pain, and charges for TENS treatment for low back pain that is performed during an otherwise-covered physical therapy visit are not covered benefits. The diagnosis code(s) must specify the location of pain on the authorization request and the claim submitted to be considered for reimbursement.
For dates of service Feb. 17, 2021 and after, units in excess of two units/four leads per month for HCPCS A4595 will not be reimbursed. Please make note of this when prescribing and billing for TENS supplies.
Transplants are a limited benefit. Transplants, excluding corneal transplants, require prior authorization for all beneficiaries. More>>