TENS Treatment Excluded for Lower Back Pain, Dry Needling Reminder
Friday, May 29, 2020
Effective June 1, 2020, TRICARE will no longer cover transcutaneous electrical nerve stimulation (TENS) for the treatment of acute, subacute and chronic low back pain (LBP). Health Net Federal Services, LLC (HNFS) is adjusting impacted authorizations for TENS treatments that extend beyond June 1, 2020, and working to notify those affected. This includes all pending authorizations, which will be revised with a May 31, 2020 end date. Beneficiaries who have an approved authorization for TENS due to LBP will need to work with their provider on an alternate treatment by May 31, 2020, to avoid out-of-pocket costs.
Please review all approved, open authorizations for TENS treatments due to LBP to determine if you have patients who may be affected.
Find authorization status details online using the Authorization Status tool.
Dry needling remains a non-covered benefit when it is the sole purpose of a visit. If a physical therapist provides dry needling in the course of an otherwise-covered physical therapy session, the visit itself may be covered, but dry needling is not separately reimbursable. When billing for dry needling in conjunction with another covered service, use of the following Current Procedural Terminology® (CPT) codes will help avoid claims processing delays: 20552, 20553, 20560, 20561, 97039, 97139 and/or 97799. Using one of these codes for the coverage of only dry needling will result in the claim denying.