Key facts for NCD 160.7.1
- Benefit category
- Incident to a physician's professional Service, Outpatient Hospital Services Incident to a Physician's Service, Outpatient Physical Therapy Services, Physicians' Services
- Effective date
- 06/19/2006
- Implemented 06/19/2006
- Transmittal
- Transmittal 48
- Versions published
- 2
- Manual chapter
- 160
- NCD Manual (Pub. 100-03)
TL;DR
NCD 160.7.1 sets Medicare's national policy for assessing patient's suitability for electrical nerve stimulation therapy under the benefit category "Incident to a physician's professional Service, Outpatient Hospital Services Incident to a Physician's Service, Outpatient Physical Therapy Services, Physicians' Services", effective 06/19/2006 and implemented 06/19/2006. Electrical nerve stimulation is an accepted modality for assessing a patient's suitability for ongoing treatment with a transcutaneous or an implanted nerve stimulator. It has been revised 1 time since publication and binds every Medicare Administrative Contractor nationally.
Indications and limitations of coverage
Electrical nerve stimulation is an accepted modality for assessing a patient's suitability for ongoing treatment with a transcutaneous or an implanted nerve stimulator.
Accordingly, program payment may be made for the following techniques when used to determine the potential therapeutic usefulness of an electrical nerve stimulator:
A. Transcutaneous Electrical Nerve Stimulation (TENS)
This technique involves attachment of a transcutaneous nerve stimulator to the surface of the skin over the peripheral nerve to be stimulated. It is used by the patient on a trial basis and its effectiveness in modulating pain is monitored by the physician, or physical therapist. Generally, the physician or physical therapist is able to determine whether the patient is likely to derive a significant therapeutic benefit from continuous use of a transcutaneous stimulator within a trial period of 1 month; in a few cases this determination may take longer to make. Document the medical necessity for such services which are furnished beyond the first month. (See § 160.13 for an explanation of coverage of medically necessary supplies for the effective use of TENS.)
If TENS significantly alleviates pain, it may be considered as primary treatment; if it produces no relief or greater discomfort than the original pain electrical nerve stimulation therapy is ruled out. However, where TENS produces incomplete relief, further evaluation with percutaneous electrical nerve stimulation may be considered to determine whether an implanted peripheral nerve stimulator would provide significant relief from pain.
Usually, the physician or physical therapist providing the services will furnish the equipment necessary for assessment. Where the physician or physical therapist advises the patient to rent the TENS from a supplier during the trial period rather than supplying it himself/herself, program payment may be made for rental of the TENS as well as for the services of the physician or physical therapist who is evaluating its use. However, the combined program payment which is made for the physician's or physical therapist's services and the rental of the stimulator from a supplier should not exceed the amount which would be payable for the total service, including the stimulator, furnished by the physician or physical therapist alone.
B. Percutaneous Electrical Nerve Stimulation (PENS)
This diagnostic procedure which involves stimulation of peripheral nerves by a needle electrode inserted through the skin is performed only in a physician's office, clinic, or hospital outpatient department. Therefore, it is covered only when performed by a physician or incident to physician's service. If pain is effectively controlled by percutaneous stimulation, implantation of electrodes is warranted.
As in the case of TENS (described in subsection A), generally the physician should be able to determine whether the patient is likely to derive a significant therapeutic benefit from continuing use of an implanted nerve stimulator within a trial period of 1 month. In a few cases, this determination may take longer to make. The medical necessity for such diagnostic services which are furnished beyond the first month must be documented.
NOTE: Electrical nerve stimulators do not prevent pain but only alleviate pain as it occurs. A patient can be taught how to employ the stimulator, and once this is done, can use it safely and effectively without direct physician supervision. Consequently, it is inappropriate for a patient to visit his/her physician, physical therapist, or an outpatient clinic on a continuing basis for treatment of pain with electrical nerve stimulation. Once it is determined that electrical nerve stimulation should be continued as therapy and the patient has been trained to use the stimulator, it is expected that a stimulator will be implanted or the patient will employ the TENS on a continual basis in his/her home. Electrical nerve stimulation treatments furnished by a physician in his/her office, by a physical therapist or outpatient clinic are excluded from coverage by §1862(a)(1) of the Act. (See § 160.7 for an explanation of coverage of the therapeutic use of implanted peripheral nerve stimulators under the prosthetic devices benefit.) See § 160.27 for an explanation of coverage of the therapeutic use of TENS under the durable medical equipment benefit.
Text reproduced from the CMS Medicare Coverage Database record for NCD 160.7.1 version 2. View the original on cms.gov.
Revision history
03/2006 - Removal of cross reference. Effective date: 06/19/2006. ( TN 48 ) (CR4278)
07/1995 - Determined that TENS covered under durable medical equipment benefit rather than prosthetic device benefit. Effective date 08/07/1995. (TN 78)
09/1988 - Added cross-reference omitted from previous transmittal. Effective date NA. (TN 33)
06/1988 - Added cross-references to section 45-25. 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 160.7.1
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 160.7.1
What does NCD 160.7.1 cover?
Electrical nerve stimulation is an accepted modality for assessing a patient's suitability for ongoing treatment with a transcutaneous or an implanted nerve stimulator. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 160.7.1 take effect?
The current version (2) is effective 06/19/2006, implemented 06/19/2006, published in transmittal 48. CMS lists 2 versions of this NCD.
Does a Local Coverage Determination override NCD 160.7.1?
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.