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I recently submitted a pre-authorization claim for a BNS-40 (Myotronics) home tENS unit. My request was denied because the insurance company utilizes the MCG Guideline for this procedure and apparently chronic TMJ pain is not a condition meeting their standard for medical necessity. My questions are the following:
1) what conditions are considered medically necessary with this MCG Guideline - A0241- Electrical Nerve Stimulation?
2) Has anyone had success in receiving benefits for home TENs units? If so, what do I do to get these benefits for my patient? Letter used?? etc.
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Hi gfdental@sbcglobal.net! Great questions. I tried looking up the MCG guidelines to see if I could help you shed some light on your first question, however it appears from their website those policies are only available to view to their clients who have purchase their software platform - here is a link to MCG's website: https://www.mcg.com/ However, I do know that many medical insurers currently list TENS/electrical nerve stim as "experimental & investigational" for a diagnosis of TMD, so do not currently offer coverage for it. For example, here is a link to Aetna's medical policy for TMD: http://www.aetna.com/cpb/medical/data/1_99/0028.htmlIn this policy, it states: "Aetna considers the following experimental and investigational for diagnosis and treatment of TMJ disorders: .....Myomonitor treatment (J-4, BNS-40, Bio-TENS)" Hope this helps, have a great day!
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