Chapter 4
Section 6.2
Bone Growth Stimulation
Issue Date: October
6, 1988
Copyright: CPT only © 2006
American Medical Association (or such other date of publication
of CPT).
All Rights Reserved.
Revision: C-1,
March 10, 2017
1.0 CPT PROCEDURE
CODES
20670, 20680, 20974 - 20975, 20979
2.0 HCPCS PROCEDURE
CODES
E0747 - E0749, E0760
3.0 DESCRIPTION
Electrical
stimulation to augment bone repair can be accomplished through one
of the following methods:
3.1 A totally invasive method in which electrodes
and power pack are surgically implanted within the extremity.
3.2 A semi-invasive
method in which electrodes penetrate the fracture and the power
pack is externally placed and the leads are connected to the inserted
electrodes.
3.3 A
totally noninvasive method in which the electrodes are placed over
the cast surface and are connected to an external power pack.
4.0 POLICY
4.1 Use of the invasive
and semi-invasive types of devices are covered for nonunion of long
bone fractures.
4.2 Use of the noninvasive type of device is
covered for the following procedures:
• Nonunion of long bone fractures.
• Failed fusion.
• Congenital pseudo-arthroses.
4.3 Use of the invasive
or noninvasive type of device is covered as an adjunct to spinal
fusions to increase the probability of fusion success for:
4.3.1 Patients at
high risk for pseudo-arthrosis, including those patients with:
• One or more failed fusions;
• Grade 2 or 3
spondylolisthesis;
• Fusions at more
than one level, or
4.3.2 Fusions performed on patients considered
to be at high risk (i.e., smokers, obese, etc.).
4.4 Nonunion, for
all types of devices. A nonunion is considered to be established
when the fracture site shows no visibly progressive signs of healing.
4.5 Ultrasound
bone growth stimulators (CPT procedure code 20979) are covered when
medically necessary and appropriate (e.g., as a treatment to promote
healing of some fresh fractures and to accelerate healing for nonunion
of other fracture sites). See Chapter 8, Section 5.1 for TRICARE policy
on medical devices.
4.6 When
determined to be medically necessary, the electrical bone stimulator
may be rented following the Durable Medical Equipment (DME) reimbursement
procedures outlined in
Chapter 8, Section 2.1.
4.7 When
determined to be medically necessary, repairs, adjustments and accessories
necessary for the effective functioning of the device, and removal
and replacement of the covered device, as well as associated surgical
costs are covered.
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