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Non-spinal Bone Growth Stimulation

Section: Surgery
Effective Date: January 01, 2020
Revised Date: November 14, 2019
Last Reviewed: November 14, 2019

Description

Bone growth stimulation is also known as osteogenesis stimulation and is used when the body’s healing process fails to heal bone injuries. The bone growth stimulation device stimulates the natural healing process of the bone by sending low-level pulses of electromagnetic energy to the injury site.

Criteria

Both invasive and noninvasive non-spinal 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 (3) months of the original fracture.

Noninvasive, non-spinal electrical bone growth stimulation may be considered medically necessary as a treatment of fracture nonunion or congenital pseudoarthrosis in the appendicular skeleton (the appendicular skeleton includes the bones of the shoulder girdle, upper extremities, pelvis and lower extremities). The diagnosis of fracture nonunion must meet ALL of the following criteria:

  • At least three (3) months have passed since the date of the fracture; and
  • Serial radiographs have confirmed that no progressive signs of healing have occurred; and
  • The fracture gap is one (1) centimeter or less; and
  • The individual can be adequately immobilized and is of an age likely to comply with non-weight bearing for fractures of the pelvis and lower extremities.

Non-spinal Electrical Bone Growth Stimulation (EBGS) will be denied as not medically necessary if the above criteria is not met.

When the doctor reports electrical stimulation, the claim should be processed under the appropriate code for electrical stimulation.

If the patient employs the stimulator at home, rental or purchase of the device may be eligible for payment. In this instance, any charges reported by the doctor for electrical stimulation should be denied as not medically necessary.

Procedure Codes

20974 20975 E0747 E0749

Diagnosis Codes

M43.00 M43.01 M43.02 M43.03 M43.04 M43.05 M43.06
M43.07 M43.08 M43.09 M43.10 M43.11 M43.12 M43.13
M43.14 M43.15 M43.16 M43.17 M43.18 M43.19 M80.00XK
M80.011K M80.012K M80.019K M80.021K M80.022K M80.029K M80.031K
M80.032K M80.039K M80.041K M80.042K M80.049K M80.051K M80.052K
M80.059K M80.061K M80.062K M80.069K M80.071K M80.072K M80.079K
M80.08XK M80.80XK M80.811K M80.812K M80.819K M80.821K M80.822K
M80.829K M80.831K M80.832K M80.839K M80.841K M80.842K M80.849K
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M84.755G M84.755K M84.755P M84.755S M84.756A M84.756D M84.756G
M84.756K M84.756P M84.756S M84.757A M84.757D M84.757G M84.757K
M84.757P M84.757S M84.758A M84.758D M84.758G M84.758K M84.758P
M84.758S M84.759A M84.759D M84.759G M84.759K M84.759P M84.759S
M96.0 Q76.2 S02.0XXK S02.10XK S02.110K S02.111K S02.112K
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S12.331K S12.34XK S12.350K S12.351K S12.390K S12.391K S12.400K
S12.401K S12.430K S12.431K S12.44XK S12.450K S12.451K S12.490K
S12.491K S12.500K S12.501K S12.530K S12.531K S12.54XK S12.550K
S12.551K S12.590K S12.591K S12.600K S12.601K S12.630K S12.631K
S12.64XK S12.650K S12.651K S12.690K S12.691K S22.000K S22.001K
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S22.9XXK S32.000K S32.001K S32.002K S32.008K S32.009K S32.010K
S32.011K S32.012K S32.018K S32.019K S32.020K S32.021K S32.022K
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S32.052K S32.058K S32.059K S32.10XK S32.110K S32.111K S32.112K
S32.119K S32.120K S32.121K S32.122K S32.129K S32.130K S32.131K
S32.132K S32.139K S32.14XK S32.15XK S32.16XK S32.17XK S32.19XK
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S32.616K S32.691K S32.692K S32.699K S32.810K S32.811K S32.82XK
S32.89XK S32.9XXK S42.001K S42.002K S42.009K S42.011K S42.012K
S42.013K S42.014K S42.015K S42.016K S42.017K S42.018K S42.019K
S42.021K S42.022K S42.023K S42.024K S42.025K S42.026K S42.031K
S42.032K S42.033K S42.034K S42.035K S42.036K S42.101K S42.102K
S42.109K S42.111K S42.112K S42.113K S42.114K S42.115K S42.116K
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S42.263K S42.264K S42.265K S42.266K S42.271K S42.272K S42.279K
S42.291K S42.292K S42.293K S42.294K S42.295K S42.296K S42.301K
S42.302K S42.309K S42.311K S42.312K S42.319K S42.321K S42.322K
S42.323K S42.324K S42.325K S42.326K S42.331K S42.332K S42.333K
S42.334K S42.335K S42.336K S42.341K S42.342K S42.343K S42.344K
S42.345K S42.346K S42.351K S42.352K S42.353K S42.354K S42.355K
S42.356K S42.361K S42.362K S42.363K S42.364K S42.365K S42.366K
S42.391K S42.392K S42.399K S42.401K S42.402K S42.409K S42.411K
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S42.423K S42.424K S42.425K S42.426K S42.431K S42.432K S42.433K
S42.434K S42.435K S42.436K S42.441K S42.442K S42.443K S42.444K
S42.445K S42.446K S42.447K S42.448K S42.449K S42.451K S42.452K
S42.453K S42.454K S42.455K S42.456K S42.461K S42.462K S42.463K
S42.464K S42.465K S42.466K S42.471K S42.472K S42.473K S42.474K
S42.475K S42.476K S42.481K S42.482K S42.489K S42.491K S42.492K
S42.493K S42.494K S42.495K S42.496K S42.90XK S42.91XK S42.92XK
S49.001K S49.002K S49.009K S49.011K S49.012K S49.019K S49.021K
S49.022K S49.029K S49.031K S49.032K S49.039K S49.041K S49.042K
S49.049K S49.091K S49.092K S49.099K S49.101K S49.102K S49.109K
S49.111K S49.112K S49.119K S49.121K S49.122K S49.129K S49.131K
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S49.199K S52.001K S52.001M S52.001N S52.002K S52.002M S52.002N
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S52.034N S52.035K S52.035M S52.035N S52.036K S52.036M S52.036N
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S52.045N S52.046K S52.046M S52.046N S52.091K S52.091M S52.091N
S52.092K S52.092M S52.092N S52.099K S52.099M S52.099N S52.101K
S52.101M S52.101N S52.102K S52.102M S52.102N S52.109K S52.109M
S52.109N S52.111K S52.112K S52.119K S52.121K S52.121M S52.121N
S52.122K S52.122M S52.122N S52.123K S52.123M S52.123N S52.124K
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S52.126N S52.131K S52.131M S52.131N S52.132K S52.132M S52.132N
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S52.91XM S52.91XN S52.92XK S52.92XM S52.92XN S59.001K S59.002K
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S92.525K S92.526K S92.531K S92.532K S92.533K S92.534K S92.535K
S92.536K S92.591K S92.592K S92.599K S92.811A S92.811B S92.811D
S92.811G S92.811K S92.811P S92.811S S92.812A S92.812B S92.812D
S92.812G S92.812K S92.812P S92.812S S92.819A S92.819B S92.819D
S92.819G S92.819K S92.819P S92.819S S92.901K S92.902K S92.909K
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S99.241K S99.241P S99.241S S99.242A S99.242B S99.242D S99.242G
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S99.249K S99.249P S99.249S S99.291A S99.291B S99.291D S99.291G
S99.291K S99.291P S99.291S S99.292A S99.292B S99.292D S99.292G
S99.292K S99.292P S99.292S S99.299A S99.299B S99.299D S99.299G
S99.299K S99.299P S99.299S Z98.1

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