The Colorado Division of Workers’ Compensation (DOWC) set specific guidelines for billing electrical stimulation devices (durable medical equipment) and related supplies in 2018.
Beginning in 2018, transcutaneous electrical nerve stimulation (TENS), all interferential machines and bundled kits, and any other type of electrical stimulator combinations kits such as H-wave are to be billed with one of two codes:
E0720 — Device with two leads for localized stimulation
E0730 — Device with four or more leads for multiple nerve stimulation
The bundled kits include the portable unit(s), two to four leads and pads, initial battery, electrical adapters and carrying case.
Kits that cost more than $300 shall be rented for the first month of use before a potential purchase. The provider should request prior authorization and document the effectiveness of the unit for the injured worker prior to purchasing devices priced over $300. The documentation of effectiveness should include the assessment of functional improvement and decreased pain.
Supplies used in in conjunction with E0745 (NMES - Neuromuscular stimulator) and the devices, E0720 and E0370, should be billed with the following code:
A4595 — Electrical stimulator supplies, 2 lead, per month, (e.g., TENS, NMES)
- This is the only code allowed for all monthly supplies used with a TENS, NMES, and all other electrical stim units. Code A4595 does not include the lead wires.
- A4595 should be used for all supplies related to these devices. Examples of what is included in A4595:
- ~A4556 — Electrodes, per pair
- ~A4558 — Conductive paste or gel used with electrical device (TENS, NMES), per ounce
- ~A4630 — Replacement batteries, medically necessary, TENS, owned by patient
- ~A4613 — Battery charger; replacement for patient owned ventilator
- ~A5120 — Electrodes (e.g. apnea monitor), per pair
- Supplies billed separately (unbundled) from A4595 will be denied.
- Supplies are included in the initial setup and should not be billed separately in the first month.
- After the first month, A4595 can be billed for replacement supplies.
— For a two-lead device, the maximum reimbursement for supplies is one unit per month.
— For a device with four or more leads, the maximum reimbursement for supplies is two units per month.
A4557 — Lead wires
- A4557 is not included in A4595. A4557 can be billed separately and is only used for replacement wires.
- A4557 should not be billed in the month the device is initially provided to the injured worker.
- Pinnacol will only reimburse A4557 once per year for use with a TENS, NMES, or any other electrical stim unit.
- Per DOWC, Rule 18, auto shipping of monthly supplies is not allowed. An affirmative request by the injured worker or prescribing provider is required.
- Pinnacol may ask for documentation that the injured worker requested the supplies.
- Per Rule 18, when the item is purchased, the rental fee will be deducted from the purchase price.
If you have any questions or need additional information, please contact Pinnacol’s provider medical billing auditors at 303.361.4940 or firstname.lastname@example.org.