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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