Key facts for NCD 160.13
- Benefit category
- Incident to a physician's professional Service
- Effective date
- 07/14/1988
- Transmittal
- Transmittal 78
- Versions published
- 1
- Manual chapter
- 160
- NCD Manual (Pub. 100-03)
TL;DR
NCD 160.13 sets Medicare's national policy for supplies used in the delivery of transcutaneous electrical nerve stimulation (tens) and neuromuscular electrical stimulation (nmes) under the benefit category "Incident to a physician's professional Service", effective 07/14/1988. A form-fitting conductive garment (and medically necessary related supplies) may be covered under the program only when: It has been revised once since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
Transcutaneous Electrical Nerve Stimulation (TENS) and/or Neuromuscular Electrical Stimulation (NMES) can ordinarily be delivered to patients through the use of conventional electrodes, adhesive tapes and lead wires. There may be times, however, where it might be medically necessary for certain patients receiving TENS or NMES treatment to use, as an alternative to conventional electrodes, adhesive tapes and lead wires, a form-fitting conductive garment (i.e., a garment with conductive fibers which are separated from the patients’ skin by layers of fabric).
Indications and limitations of coverage
A form-fitting conductive garment (and medically necessary related supplies) may be covered under the program only when:
1. It has received permission or approval for marketing by the Food and Drug Administration;
2. It has been prescribed by a physician for use in delivering covered TENS or NMES treatment; and
3. One of the medical indications outlined below is met:
• The patient cannot manage without the conductive garment because there is such a large area or so many sites to be stimulated and the stimulation would have to be delivered so frequently that it is not feasible to use conventional electrodes, adhesive tapes and lead wires;
• The patient cannot manage without the conductive garment for the treatment of chronic intractable pain because the areas or sites to be stimulated are inaccessible with the use of conventional electrodes, adhesive tapes and lead wires;
• The patient has a documented medical condition such as skin problems that preclude the application of conventional electrodes, adhesive tapes and lead wires;
• The patient requires electrical stimulation beneath a cast either to treat disuse atrophy, where the nerve supply to the muscle is intact, or to treat chronic intractable pain; or
• The patient has a medical need for rehabilitation strengthening (pursuant to a written plan of rehabilitation) following an injury where the nerve supply to the muscle is intact.
A conductive garment is not covered for use with a TENS device during the trial period specified in §160.3 unless:
4. The patient has a documented skin problem prior to the start of the trial period; and
5. The B/Medicare Administrative Contractor’s medical consultants are satisfied that use of such an item is medically necessary for the patient.
(See conditions for coverage of the use of TENS in the diagnosis and treatment of chronic intractable pain in §§160.3, 160.13 , and 160.27 , and the use of NMES in the treatment of disuse atrophy in §150.4.)
Text reproduced from the CMS Medicare Coverage Database record for NCD 160.13 version 1. View the original on cms.gov.
Revision history
07/1995 - Specified that TENS covered under durable medical equipment benefit rather than prosthetic device benefit. Effective date 08/07/1995. (TN 78)
06/1988 - Established conditions under which supplies may be covered. Effective date 07/14/1988. (TN 26)
How this NCD shows up on remittances
A service denied under a National Coverage Determination returns CARC 50 (not deemed medically necessary) with remark N386 (decision based on an NCD); a denial citing a local policy instead carries N115. Because NCDs bind nationally, the appeal path is documentation that the patient meets the indications above, not a contractor-policy argument.
How QuickIntell applies NCD 160.13
QuickAuth checks the ordered service and diagnosis against NCD and LCD criteria before the encounter, QuickCode validates the diagnosis pairing on the claim, and QuickRCM routes CARC 50 denials with the policy text and the covered-code list attached so the appeal starts with evidence.
Frequently asked questions — NCD 160.13
What does NCD 160.13 cover?
A form-fitting conductive garment (and medically necessary related supplies) may be covered under the program only when: The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 160.13 take effect?
The current version (1) is effective 07/14/1988, published in transmittal 78. This is the only published version.
Does a Local Coverage Determination override NCD 160.13?
No. A National Coverage Determination binds all Medicare Administrative Contractors; an LCD can only address services or circumstances the NCD leaves open. Claims denied under this NCD typically return CARC 50 with remark N386 (NCD) rather than N115 (LCD).
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database NCDs via the CMS Coverage APIVersion API snapshot 2026-09-27 · effective 2026-09-20 · file national-coverage-ncd.jsonSHA-256 a90fadfd264b9ef4…
Disclaimer
This page reproduces the CMS National Coverage Determination text and, for laboratory NCDs, the CMS ICD-10 edit lists, as an operational reference. Coverage decisions depend on the full policy, the claim and the contractor; nothing here is legal, clinical or billing advice. CPT codes are shown as numbers only; CPT descriptors are copyright AMA.