Coverage Decisions for Medical Technologies & Procedures

Bone Growth Stimulators

Several types of bone growth stimulators are reported to aid in the healing of bone fractures.

Non-invasive or external stimulators

This category includes those that create a small electrical current and magnetic field or those that provide a low-intensity pulsed ultrasonic wave to the fracture site.

Implantable or invasive stimulators

This type applies an electrical current directly to the bone.

When will the insurer pay for the use of a bone growth stimulator?

The insurer will pay for a bone growth stimulator when:

• It is proper and necessary,
• The claim manager provides prior authorization, and
• The indications for use match the approved indications.

What are the approved indications?

The following approved indications are covered for these bone growth stimulators:

1. Noninvasive electrical:
• This stimulator is covered for nonunion of long bone fractures and when the fracture does not visibly show signs of healing.
• Long bones include the:
• Clavicle,
• Humerus,
• Radius,
• Ulna,
• Femur,
• Tibia,
• Fibula,
• Metacarpal, and
• Metatarsal bones.
• Fracture nonunion must be documented by a minimum of 2 sets x-rays. The first/baseline x-ray is done at the time of injury or the date of surgery. The second is done at least 90 days later. Each X-ray includes mulitple views of the fractured site.
  
  The physician submits a written interpretation of the second set of x-rays stating that there has been no clinically significant healing between the 2 sets of x-rays.
  or
  The stimulator will be used for spinal applications for a failed fusion where a minimum of 9 months has elasped since the last surgery.
2. Non-invasive ultrasound:
• This stimulator is covered for a nonunion of bone.
• This stimulator is not covered for:
• Skull,
• Vertebrae,
• Tumor-related bones, and
• Long bones.
• Fracture nonunion must be documented by a minimum of 2 sets x-rays. The first/baseline x-ray is done at the time of injury or the date of surgery. The second is done at least 90 days later. Each X-ray includes mulitple views of the fractured site.
  
  The physician submits a written interpretation of the second set of x-rays stating that there has been no clinically significant healing between the 2 sets of x-rays.
3. Implantable:
• This stimulator is covered for nonunion of long bone fractures.
• Fracture nonunion must be documented by a minimum of 2 sets x-rays. The first/baseline x-ray is done at the time of injury or the date of surgery. The second is done at least 90 days later. Each X-ray includes mulitple views of the fractured site.
  
  The physician submits a written interpretation of the second set of x-rays stating that there has been no clinically significant healing between the 2 sets of x-rays.
  or
  As an adjunct to spinal surgery for patients at high risk of pseudoarthrosis due to previously failed spinal fusion at the same site or for those undergoing multiple level fusion.
Note: For State Fund claims, a utilization review vendor makes a recommendation to L&I whether an implantable stimulator is medically appropriate. L&I determines whether the treatment is proper and necessary.

Billing codes

Billing code	Description	Prior authorization
E0747	Osteogenesis stimulator, electrical, noninvasive, other than spinal application	Required
E0748	Osteogenesis stimulator, electrical, noninvasive, spinal application	Required
E0749	Osteogenesis stimulator, electrical (surgically implanted)	Required
E0760	Osteogenesis stimulator, low intensity ultrasound, noninvasive	Required

---

For more information:
Contact information.
Medical Aid Rules and Fee Schedule.