June 3, 2020
Tricare has recently made the following announcements regarding its TENS and dry needling payment policies.
TENS
Effective June 1, 2020, TRICARE will no longer cover transcutaneous electrical nerve stimulation (TENS) for the treatment of acute, subacute, and chronic low back pain (LBP). Health Net Federal Services, LLC (HNFS) is adjusting impacted authorizations for TENS treatments that extend beyond June 1, 2020, and working to notify those affected. This includes all pending authorizations, which will be revised with a May 31, 2020 end date. Beneficiaries who have an approved authorization for TENS due to LBP will need to work with their provider on an alternate treatment by May 31, 2020 to avoid out-of-pocket costs.
Dry Needling
Dry needling remains a non-covered benefit when it is the sole purpose of a visit. If a physical therapist provides dry needling in the course of an otherwise-covered physical therapy session, the visit itself may be covered, but dry needling is not separately reimbursable. Tricare states that when billing for dry needling in conjunction with another covered service, use of the following codes will help avoid claims processing delays: 20552, 20553, 20560, 20561, 97039, 97139 and/or 97799. Using one of these codes for the coverage of only dry needling will result in the claim denying. [Note: We recommend that PTs use codes 20560 and 20561 for dry needling for Tricare patients.)
