Extracorporeal shock wave therapy (ESWT) is designed to provide a non-surgical, non-invasive alternative for treating musculoskeletal conditions by bombarding the surface of the treatment area with acoustic shock waves.
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.
Coverage is subject to the specific terms of the member’s benefit plan.
ESWT, high- or low-dose protocol or radial ECWT is considered experimental/investigational as a treatment for musculoskeletal conditions, including but not limited to:
Scientific evidence does not convincingly demonstrate the efficacy of ESWT for musculoskeletal conditions.