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| Section: | Surgery |
| Number: | S-89 |
| Topic: | Bone Growth Stimulation |
| Effective Date: | August 1, 2005 |
| Issued Date: | March 27, 2006 |
| Date Last Reviewed: | 03/2006 |
Indications and Limitations of Coverage
Nonspinal Electrical Bone Growth Stimulation (EBGS) A non-union fracture (733.82) is defined as a fracture that has not united within a minimum of three months of the original fracture. Electrical stimulation of a non-united fracture is a procedure whereby electrodes are placed either at the fracture site (invasive/operative) (20975) or around the fracture site (non-invasive/non-operative) (20974). Electrical current is delivered to the fracture promoting osteogenesis within the previously non-united fracture. Invasive electrical bone growth stimulation is eligible for payment in the treatment of a non-united fracture. Noninvasive, nonspinal electrical bone growth stimulation is covered for the following conditions:
Nonspinal Electrical Bone Growth Stimulation (EBGS) will be denied as not medically necesary if none of the preceding conditions are present. A participating, preferred, or network provider cannot bill the member for the denied service. When the doctor reports electrical stimulation, the claim should be processed under the appropriate code for electrical stimulation (codes 20974-20975). Use of the device is included in the doctor's global allowance for the electrical stimulation (i.e., no separate payment can be made for the device). A participating, preferred, or network provider cannot bill the member for the device itself. However, if the patient employs the stimulator at home, rental or purchase of the device (code E0747) may be eligible for payment. In this instance, any charges reported by the doctor for electrical stimulation should be denied as not medically necessary. A participating, preferred, or network provider cannot bill the member for the denied service. Re-casting is considered part of the global surgical allowance for the stimulation. Therefore, re-casting is not eligible for separate payment. For ultrasound stimulation see Medical Policy Bulletin E-35. EBGS and Spinal Fusion Invasive EBGS of the spine should be reported under code 20975 and processed in accordance with multiple surgery payment guidelines. As an adjunct to spinal fusion surgery, noninvasive EBGS can begin within 30 days after the most recent fusion procedure. As a nonsurgical salvage for pseudoarthrosis, EBGS can be applied after a minimum of six months (after surgery) has passed. Noninvasive EBGS of the spine should be reported under code 20974. However, if the patient employs the stimulator at home, coverage for the rental or purchase of the device (code E0748) is determined according to individual or group customer benefits. In this instance, any charges reported by the doctor for EBGS of the spine should be denied as not medically necessary. A participating, preferred, or network provider cannot bill the member for the denied service. Description EBGS and Spinal Fusion Spinal fusion has been used to restore stability in a number of congenital, acquired, and degenerative spinal disorders. Failure to obtain spinal fusion has persisted over the years as a relatively common problem. Electrical bone growth stimulation (EBGS) of the spine is a procedure which promotes the healing process by applying a direct electrical current to the spine. EBGS is utilized for patients at high risk for pseudoarthrosis. High risk factors include: previous failed fusion, multilevel fusion, and grade II or worse spondylolisthesis (i.e., anteriorlisthesis). This process can be performed as an invasive or noninvasive procedure, depending on the needs of the patient. Invasive EBGS of the spine involves the insertion of a bone stimulation device directly into the area of spinal surgery after the fusion procedure has been completed. Noninvasive EBGS of the spine is a procedure which involves the use of an external power supply and externally applied coils which generate a current through the site where bone growth is desired. |
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| 20974 | 20975 | E0747 | E0748 |
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PRN References 08/2001, Electrical bone growth stimulation eligible for non-union fractures |
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This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.
Medical policies are designed to supplement the terms of a member's contract. The member's contract defines the benefits available; therefore, medical policies should not be construed as overriding specific contract language. In the event of conflict, the contract shall govern.
Medical policies do not constitute medical advice, nor the practice of medicine. Rather, such policies are intended only to establish general guidelines for coverage and reimbursement under Mountain State Blue Cross Blue Shield plans. Application of a medical policy to determine coverage in an individual instance is not intended and shall not be construed to supercede the professional judgment of a treating provider. In all situations, the treating provider must use his/her professional judgment to provide care he/she believes to be in the best interest of the patient, and the provider and patient remain responsible for all treatment decisions.
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