Bone Growth Stimulation Devices*

Medical Policy: 07.01.05 
Original Effective Date: August 1992 
Reviewed: June 2007 
Revised: June 2000 

This policy applies to all products unless specific contract limitations, exclusions or exceptions apply. Please refer to the member's coverage manual for benefit availability. Managed care guidelines related to referral authorization, and precertification of inpatient hospitalization, home health, home infusion and hospice services apply.

Description: 

Generally, bone fractures heal normally with standard fracture care.  Occasionally, the healing process stops due to added risks or complications.  It has been proven that electric current can stimulate bone growth and enhance the healing process.

Several electrical bone growth stimulators are available.  The noninvasive type of stimulator is comprised of coils or electrodes, which are placed on the skin near the fracture site. The invasive type includes percutaneous and implanted devices.  The percutaneous type involves electrode wires inserted through the skin into the bone while implanted devices include a generator placed under the skin or in the muscles near the gap between the ends of the bones, which have not fused.  The implanted devices are surgically placed and later surgically removed.

The ultrasound fracture-healing device uses sound waves to heal bones.  This device sends out low frequency sound waves to promote faster healing of fresh fractures.  An opening is created in the cast and the device is applied to the skin.  The device is typically used for twenty minutes each day.

Definition of nonunion: The FDA labeling suggests that a nonunion is considered to be established when the fracture site shows no visibly progressive signs of healing, without giving any guidance regarding the time frame. However, it is suggested that a reasonable time period for lack of visible signs of healing is three months.

Policy: 

Noninvasive electrical bone growth stimulators may be considered medically necessary for both of the following conditions: 
  • Treatment of fracture nonunions; The diagnosis of fracture nonunion must meet all of the following criteria:
  • At least three months have passed since the date of fracture
  • Serial radiographs confirm that no progressive signs of healing have occurred
  • The fracture gap is one cm or less, and 
  • The patient can be adequately immobilized and is of an age likely to comply with non-weight bearing
  • Treatment of congenital pseudoarthroses in the appendicular skeleton (the appendicular skeleton includes the bones in the shoulder girdle, upper extremities, pelvis and lower extremities).

Invasive or noninvasive electric bone growth stimulators may be considered medically necessary as an adjunct to spinal fusion surgery for patients with any of the following high risks for failed spinal fusion:

  • One or more failed spinal fusions
  • Grade III or worse spondylolisthesis
  • Multi-level fusions, or 
  • Current smoking habit, diabetes, renal disease or alcoholism

Low intensity ultrasound treatment may be considered medically necessary when used as an adjunct to conventional management (i.e. closed reduction and cast immobilization) for the treatment of fresh, closed fractures when there is high risk for delayed fracture healing or nonunion. The member must have at least one of the following risk factors from either category, fracture locations or comorbidities:

Fracture locations:

  • Jones fracture
  • Fracture of the navicular bone in the wrist
  • Fracture of the metatarsal
  • Fractures associated with extensive soft tissue or vascular damage

Member co-morbidities:

  • Diabetes
  • Steroid therapy
  • Osteoporosis
  • History of alcoholism
  • History of smoking

Low intensity ultrasound treatment may be considered medically necessary as a treatment of fracture nonunions of bones when all of the following criteria are met:

  • At least three months have passed since the date of fracture
  • Serial  radiographs have confirmed that no progressive signs of healing have occurred
  • The fracture gap is one cm or less
  • The patient can be adequately immobilized and is of an age where they are likely to comply with non-weight bearing, and 
  • The fracture does not involve the skull and vertebra 

Prior approval is recommended. Submit a prior approval now.

Fracture healing devices are not a covered benefit under the following circumstances:
Invasive and non-invasive electrical bone growth stimulators are considered investigational when:

  • The fracture is fresh
  • The fracture shows delayed union, i.e. x-ray of the fracture shows decelerating healing process
  • Patients with active osteomyelitis, or 
  • Fractures due to cancer

Low intensity ultrasound treatment is considered investigational for any condition not listed above, including but not limited to:

  • Delayed union or congenital pseudoarthrosis or 
  • Open fractures


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Procedure Codes and Billing Guidelines: 

  • To report provider services, use appropriate CPT** codes, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or ICD-9 diagnostic codes.
  • We recommend providers use the following coding conventions:
    • CPT 20974 electrical stimulation to aid bone healing; non-invasive (non-operative)
    • CPT 20975 electrical stimulation to aid bone healing; invasive (operative)
    • CPT 20979 low intensity ultrasound stimulation to aid bone healing, non-invasive
    • HCPCS E0747 osteogenesis stimulator, electrical, noninvasive, other than spinal application
    • HCPCS E0748 osteogenesis stimulator, electrical, noninvasive, spinal applications
    • HCPCS E0749 osteogenesis stimulator, electrical, surgically implanted
    • HCPCS E0760 osteogenesis stimulator, low intensity ultrasound

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Selected References: 

  • Summary of Safety and Effectiveness Data. Exogen 2000® or Sonic Accelerated Fracture Healing System (SAFHS®). Exogen 2000®, a Smith and Nephew Co., 10 Constitution Avenue, Piscataway, N.J.
  • Busse JW, Bhandari M, Kulkarni AV et al. The effect of low-intensity pulsed ultrasound therapy on time to fracture healing: a meta-analysis. CMAJ 2002;166(4):437-41.
  • Connolly JF. Electrical treatment of nonunions. Its use and abuse in 100 consecutive fractures. Orthop Clin North Am 1984;15(1):89-106.
  • Akai M, Kawashima N, Kimura T et al. Electrical stimulation as an adjunct to spinal fusion: a meta-analysis of controlled clinical trials. Bioelectromagnetics 2002;23(7):496-504.
  • Agency for Healthcare Research and Quality (AHRQ).  Technology Assessment Program. The role of bone growth stimulating devices and orthobiologics in healing nonunion fractures. [09/21/2005] 

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New information or technology that would be relevant for Wellmark to consider when this policy is next reviewed may be submitted to:

Wellmark Blue Cross and Blue Shield
Medical Policy Analyst
Station 304
636 Grand Ave
Des Moines, Iowa 50309

*Prior approval is recommended for this policy.

**Current Procedural Terminology © 2008 American Medical Association. All Rights Reserved.

Wellmark medical policies address the complex issue of technology assessment of new and emerging treatments, devices, drugs, etc.   They are developed to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Wellmark medical policies contain only a partial, general description of plan or program benefits and do not constitute a contract. Wellmark does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Wellmark or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. Our medical policies may be updated and therefore are subject to change without notice.