ModifiedBlue Cross Blue Shield of VermontPolicy 7.01.VT07

Electrical Bone Growth Stimulation of the Appendicular Skeleton

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This policy governs coverage and medical-necessity determinations for noninvasive, implantable, and semi-invasive electrical bone growth stimulation for appendicular-skeleton conditions for Blue Cross Blue Shield of Vermont members, subject to the applicable benefit plan.

Policy Summary

PayerBlue Cross Blue Shield of Vermont

PolicyElectrical Bone Growth Stimulation of the Appendicular Skeleton

Policy CodePolicy 7.01.VT07

Change TypeModified — E0747 now requires prior approval

Effective DateOct 1, 2026

Last ReviewJan 1, 2026

Next Review DateJan 1, 2027

Key ActionObtain prior approval for E0747 before providing the service.

SourceLink

POLICY UPDATE CHANGES

The July 2026 policy update moved code E0747 from the investigational coding category to the category requiring prior approval.

In January 2026, code E0747 was removed from the investigational classification and moved to requiring prior approval.

In July 2026, following external feedback, code E0747 was removed from the investigational classification and assigned to requiring prior approval.

3 monthsMinimum time from fracture

1 cmMaximum fracture-gap size

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ModifiedBlue Cross Blue Shield of VermontPolicy 7.01.VT07

Electrical Bone Growth Stimulation of the Appendicular Skeleton

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Sign up for bcbsvermont Policy 7.01.VT07 alerts

Get alerted when Policy 7.01.VT07 changes without checking for updates manually.

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Policy Summary

PayerBlue Cross Blue Shield of Vermont

PolicyElectrical Bone Growth Stimulation of the Appendicular Skeleton

Policy CodePolicy 7.01.VT07

Change TypeModified — E0747 now requires prior approval

Effective DateOct 1, 2026

Last ReviewJan 1, 2026

Next Review DateJan 1, 2027

Key ActionObtain prior approval for E0747 before providing the service.

SourceLink

POLICY UPDATE CHANGES

The July 2026 policy update moved code E0747 from the investigational coding category to the category requiring prior approval.

In January 2026, code E0747 was removed from the investigational classification and moved to requiring prior approval.

In July 2026, following external feedback, code E0747 was removed from the investigational classification and assigned to requiring prior approval.

3 monthsMinimum time from fracture

1 cmMaximum fracture-gap size

Required nonunion criteria

E0747Code requiring prior approval

InvestigationalImplantable and semi-invasive stimulators

12Covered diagnosis codes

Medical Necessity and Investigational Applications

Medically necessary noninvasive stimulation for fracture nonunion

Noninvasive electrical bone growth stimulation may be considered medically necessary for fracture nonunions or congenital pseudoarthrosis in the appendicular skeleton. For fracture nonunion, all of the following must be met:

Fracture nonunion requirements

Time since fracture: At least 3 months have passed since the date of fractureat least 3 months
Radiographic nonhealing: Serial radiographs have confirmed that no progressive signs of healing have occurredno progressive signs of healing
Fracture gap: The fracture gap is 1 cm or less1 cm or less
Immobilization: The patient can be adequately immobilizedadequate immobilization
Non-weight-bearing compliance: For fractures of the pelvis and lower extremities, the patient is of an age likely to comply with non-weight bearingage likely to comply
Applies to pelvic and lower-extremity fractures

Investigational applications

Investigational applications include, but are not limited to, the following. Applications listed below are not covered as medically necessary under this policy.

Immediate postsurgical treatment after appendicular skeletal surgery
Stress fracture: Treatment of stress fractures
Fresh fracture: Treatment of fresh fractures
Delayed union: Treatment of delayed union
Arthrodesis: Treatment of arthrodesis

Implantable and semi-invasive electrical bone growth stimulators are considered investigational under this policy.

The listed applications are denied as Not Medically Necessary and Non-Covered. This includes electrical stimulation for immediate postsurgical treatment after appendicular skeletal surgery, stress fractures, fresh fractures, delayed union, arthrodesis, and failed arthrodesis, as well as invasive electrical stimulation to aid bone healing and surgically implanted electrical osteogenesis stimulators.

Covered, Investigational, and Prior Approval Codes

Prior approval coding updateHCPCS

E0747

ICD-10-CM coding table referenceICD-10

Q74.0

InvestigationalmixedExperimental

20975	Electrical stimulation to aid bone healing; invasive (operative).
E0749	Osteogenesis stimulator, electrical, surgically implanted.

ICD-10-CM codes considered medically necessary when applicable criteria are metICD-10Covered

Q74.0	Other congenital malformations of upper limb(s), including shoulder girdle (includes congenital pseudoarthrosis of clavicle).
S32.2xxK-S32.9xxK	Fracture of coccyx.
S42.00xK-S42.92xK	Fracture of shoulder and upper arm.
S49.00xK-S49.199K	Other and unspecified injuries of shoulder and upper arm.
S52.00xK-S52.92xN	Fracture of forearm.
S59.00xK-S59.299K	Other and unspecified injuries of elbow and forearm.
S62.00xK-S62.92xK	Fracture at wrist and hand level.
S72.00xK-S72.92xN	Fracture of femur.
S79.00xK-S79.199K	Other and unspecified injuries of hip and thigh.
S82.00xK-S82.92xN	Fracture of lower leg, including ankle.

1–10 of 12

1/2

Time Since Fracture

Minimum time since fractureAt least 3 months must have passed since the date of fracture.

Fracture Gap

Maximum fracture gapThe fracture gap must be 1 cm or less.

Radiographic Healing

Required radiographic findingSerial radiographs must confirm that no progressive signs of healing have occurred.

Authorization, Documentation, and Denial Risks

Prior Authorization

Prior Approval and Benefit Verification

Prior approval is required for services outlined in this policy. Verify the member’s benefits before providing the service, including any applicable exclusions, contract limitations, or group-specific requirements.

Contact the member’s health plan or customer service department to confirm benefit availability.
For ASO, NEHP/ABNE, and FEP members, verify benefits through the applicable plan documents or customer service resources.

Prior Authorization

E0747 Requires Prior Approval

Effective July 2026, code E0747 was moved from investigational to the prior-approval category. Obtain prior approval before billing or providing this service.

Apply the July 2026 coding and utilization-management change.
Do not classify E0747 as investigational based on the prior January 2026 policy update.

Clinical Background

Electrical bone growth stimulation has been studied for conditions involving the appendicular skeleton, including fresh fractures, stress fractures, delayed union, nonunion, congenital pseudoarthrosis, and arthrodesis. The policy finds sufficient evidence for noninvasive stimulation in fracture nonunion, but insufficient evidence for delayed union, fresh fractures, stress fractures, and postsurgical use. Evidence for implantable and semi-invasive stimulation is limited to a small number of case series.

Fracture-Healing Definitions

Fresh Fracture

Fresh fracture periodA fracture is most commonly defined as fresh for 7 days after the fracture occurs.

Delayed Union

Healing processA decelerating healing process determined by serial X-rays.

Clinical and radiologic findingsLack of clinical and radiologic evidence of union, bony continuity, or bone reaction at the fracture site.

DurationThe findings must persist for no less than 3 months from the index injury or the most recent intervention.

Fractured Nonunion

Policy Summary

PayerBlue Cross Blue Shield of Vermont

PolicyElectrical Bone Growth Stimulation of the Appendicular Skeleton

Policy CodePolicy 7.01.VT07

Change TypeModified — E0747 now requires prior approval

Effective DateOct 1, 2026

Last ReviewJan 1, 2026

Next Review DateJan 1, 2027

Key ActionObtain prior approval for E0747 before providing the service.

SourceLink

On This Page

Failed arthrodesis: Treatment of failed arthrodesis

Billing Rule

E0747 Coding Status Updated

E0747 requires prior approval under the current policy. The code was removed from the investigational classification and assigned to prior approval in July 2026.

Confirm authorization requirements before service delivery.
Use the current policy implementation guidance when determining the code’s status.

Documentation Required

Required Nonunion Documentation

Document all required criteria supporting fracture nonunion before requesting coverage for noninvasive electrical bone growth stimulation. The clinical record must establish the fracture timeline, lack of healing, fracture-gap measurement, and that the fracture site can be appropriately accessed and managed.

Date of fracture and confirmation that at least 3 months have passed.
Serial radiographs showing no progressive signs of healing.
Fracture gap measuring 1 cm or less.
Ability to adequately immobilize and access the fracture site.
For pelvic and lower-extremity fractures, documentation that the patient is likely to comply with non-weight bearing.

Denial Risk

Investigational Clinical Applications

Electrical bone growth stimulation is investigational for several clinical applications and should not be represented as medically necessary under this policy.

Immediate postsurgical treatment after appendicular skeletal surgery.
Stress fractures or fresh fractures.
Delayed union, arthrodesis, or failed arthrodesis.

Denial Risk

Implantable and Semi-Invasive Devices

Implantable and semi-invasive electrical bone growth stimulators are investigational under this policy. Confirm the device type and route of administration before submitting a request.

Do not treat implantable or semi-invasive stimulators as covered noninvasive stimulation.

Denial Risk

Denial Risk: Nonunion Criteria

Coverage for fracture nonunion depends on meeting all required clinical criteria. If any criterion is not met or is not adequately documented, the service may be denied.

At least 3 months since the fracture date.
No progressive healing on serial radiographs.
Fracture gap of 1 cm or less.
Adequate immobilization is possible.
For pelvic and lower-extremity fractures, the patient is likely to comply with non-weight bearing.

Denial Risk

Denial Risk: Investigational Procedure or Implanted Device

Invasive electrical stimulation and surgically implanted electrical osteogenesis stimulators are listed as investigational and may be denied as not medically necessary or non-covered.

CPT 20975 — electrical stimulation to aid bone healing; invasive (operative).
HCPCS E0749 — osteogenesis stimulator, electrical, surgically implanted.

Failure of healing progression

Failure of progression of fracture healing for at least 3 consecutive months.

Time since fractureAt least 6 months must have elapsed following the fracture.

Clinical symptomsAccompanied by symptoms such as pain or difficulty bearing weight.