|Highmark West Virginia Medical Policy Bulletin|
|Topic:||Bone Growth Stimulation|
|Effective Date:||August 1, 2005|
|Issued Date:||January 17, 2011|
|Date Last Reviewed:|
General Policy Guidelines
Indications and Limitations of Coverage
Nonspinal Electrical Bone Growth Stimulation (EBGS)
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 (noninvasive/non-operative) (20974). Electrical current is delivered to the fracture promoting osteogenesis within the previously non-united fracture.
Both invasive and noninvasive nonspinal electrical bone growth stimulation are eligible for payment in the treatment of a non-united fracture. A non-united fracture is defined as a fracture that has not healed within a minimum of three months of the original fracture.
Noninvasive electrical bone growth stimulation may be considered medically necessary as treatment of fracture nonunions or congenital pseudoarthroses in the appendicular skeleton (the appendicular skeleton includes the bones of the shoulder girdle, upper extremeties, pelvis, and lower extremeties). The diagnosis of fracture nonunion or congenital pseudoarthroses must meet ALL of the following criteria:
Investigational applications of electrical bone growth stimulation include, but are not limited to, the treatment of fresh fractures or delayed union. Delayed union is defined as a decelerating fracture healing process, as identified by serial x-rays.
Nonspinal Electrical Bone Growth Stimulation (EBGS) will be denied as not medically necesary if none of the preceding conditions are present.
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.
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.
Services that do not meet the medical necessity criteria on this policy will be considered not medically necessary. Effective January 26, 2009, a participating, preferred, or network provider cannot bill the member for the denied service unless the provider has given advance written notice, informing the member that the service may be deemed not medically necessary and providing an estimate of the cost. The member must agree in writing to assume financial responsibility, in advance of receiving the service. The signed agreement should be maintained in the provider's records.
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.
Managed Care POS Guidelines
Blue Cross Blue Shield Association Medical Policy 7.01.07 (Electrical Bone Growth Stimulation of the Appendicular Skeleton)
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Procedure Code Attachments