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Ohio Laws and Rules
(A) A self-insuring employer may approve payment for a transcutaneous electric nerve stimulator (TENS) unit for treatment of allowed conditions in a claim directly resulting from an allowed industrial injury or occupational disease as provided in this rule and in the bureau’s provider billing and reimbursement manual.
(1) The injured worker’s physician of record must request prior authorization from the self-insuring employer in order to have a prescribed transcutaneous electrical nerve stimulator (TENS) unit and supplies furnished. Each injured worker who requires a TENS unit will be provided only one unit at a time. For each TENS unit request approved, the unit will be rented for a trial period lasting a minimum of one month but not to exceed four months preceding purchase of the TENS unit, in order to evaluate the medical necessity and effectiveness of the TENS treatment.
(2) The medical necessity and effectiveness of the TENS treatment shall be evaluated each month during the trial period. TENS treatment will be discontinued at the end of any trial period month where the treatment is not proven medically necessary or effective. The bureau will only pay rental costs through the month during the trial period that the TENS unit was actually used before treatment was discontinued.
(3) The self-insuring employer will authorize the purchase of the TENS unit only if the analysis at the end of the trial period establishes that the TENS treatment was medically necessary and effective during the entire trial period. All rental payments previously made by the self-insuring employer will be applied to the purchase price of the TENS unit. A TENS unit purchased by the self-insuring employer and furnished to the injured worker is not the personal property of the worker, however, but remains the property of the self-insuring employer. At its discretion, the self-insuring employer reserves the right to reclaim and recover the TENS unit from the injured worker at the completion of the course of TENS treatment. Once a TENS unit is purchased, the self-insuring employer will reimburse for repair or replacement, at its discretion, upon submission of a request for such from the physician of record, along with medical documentation substantiating the continued medical necessity and effectiveness of the unit. Additionally, while the injured worker continues to use the TENS unit and to order supplies, the physician of record must provide medical documentation annually substantiating the need for continued use of the unit.
(B) Injured workers who have TENS units must complete and submit to the TENS provider a monthly written request for specific supplies needed in the following month. The TENS provider will deliver the supplies and bill the self-insuring employer for them only after the injured worker’s written request is received by the TENS provider. The self-insuring employer will not pay TENS providers unless the written request was submitted by the injured worker to the TENS provider prior to delivery of supplies. The provider shall retain the original written request for supplies for a minimum of two years after the date of service for the shipment to which it applies. The TENS provider must bill monthly for each shipment of supplies sent to the injured worker. The bill must indicate the actual date of service reflecting the date that services or supplies were provided. The self-insuring employer may adjust bills upon audit if the audit discloses the provider’s failure to comply with this rule.
(C) The TENS provider shall maintain the following records and make them available upon request:
(1) The injured worker’s monthly written requests;
(2) Records of the provider’s wholesale purchase of TENS supplies or equipment; and,
(3) Records of delivery of supplies to injured workers and of the delivery or return of TENS units.
If records are requested, the provider shall supply copies of the information at no extra cost. Failure to provide the bureau with requested records will result in denial or adjustment of bills related to the records in question.
(D) Self-insuring employers may approve payment for a neuromuscular electrical stimulator (NMNS) unit for treatment of allowed conditions in a claim directly resulting from an allowed industrial injury or occupational disease, as provided in the bureau’s provider billing and reimbursement manual.
HISTORY: Eff 9-1-93; 3-1-04
Rule promulgated under: RC 119.03
Rule authorized by: RC 4121.121, 4121.30, 4123.05
Rule amplifies: RC 4123.66
RC 119.032 review dates: 11/28/03, 3/01/09