Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerPolicy UpdatesOrthopedics/MusculoskeletalBCBS Vermont Spine Stimulation Coverage | OpenPaye…
    Ask Trek AI about this page
    CurrentBlue Cross Blue Shield of VermontPolicy 7.01.VT85

    Electrical Stimulation of the Spine as an Adjunct to Spinal Fusion Procedures

    Customize your policy alerts

    Sign up for bcbsvermont Policy 7.01.VT85 alerts

    Get alerted when Policy 7.01.VT85 changes without checking for updates manually.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Coverage and prior approval for invasive and noninvasive electrical bone growth stimulation used with spinal fusion surgery or to treat failed spinal fusion, subject to the member’s applicable benefit plan.

    Policy Summary
    PayerBlue Cross Blue Shield of Vermont
    PolicyElectrical Stimulation of the Spine as an Adjunct to Spinal Fusion Procedures
    Policy CodePolicy 7.01.VT85
    Change TypeNo material change
    Effective DateJan 1, 2026
    Last ReviewSep 1, 2025
    Next Review DateSep 1, 2026
    Key ActionObtain prior approval for each listed CPT and HCPCS code when submitting electrical bone growth stimulation.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    8High-risk factors for lumbar fusion failure
    6 monthsMinimum time after surgery for failed fusion

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    3 monthsRadiographic observation period
    4Covered billing codes
    Prior approvalAuthorization requirement
    InvestigationalCervical coverage stance

    Medical Necessity and Investigational Criteria

    Adjunct to High-Risk Lumbar Spinal Fusion

    Either invasive or noninvasive electrical bone growth stimulation may be considered medically necessary as an adjunct to lumbar spinal fusion surgery when the patient is at high risk for fusion failure.

    ALL of the following

    • The electrical bone growth stimulation method is invasive or noninvasive.

    • ANY of the following high-risk fusion-failure criteria

      • One or more previous failed spinal fusion(s).
      • Grade 3 or worse spondylolisthesis.
      • Fusion to be performed at more than one level.
      • Current tobacco use.
      • Diabetes.
      • Renal disease.
      • Alcoholism.
      • Steroid use.

    Treatment of Failed Lumbar Spinal Fusion

    Noninvasive electrical bone stimulation may be considered medically necessary as a treatment for failed lumbar spinal fusion when the following criteria are met.

    ALL of the following

    • The electrical bone stimulation method is noninvasive.
    • The lumbar spinal fusion has not healed at a minimum of 6 months after the original surgery, as evidenced by serial radiographs over a course of 3 months.

    Not Medically Necessary

    Electrical stimulation is not medically necessary when the applicable medical-necessity criteria are not met.

    The applicable criteria for medically necessary electrical stimulation are not met.

    Investigational Lumbar Stimulation

    Semi-invasive electrical stimulation is considered investigational for either of the following lumbar indications.

    ANY of the following

    • Semi-invasive electrical stimulation as an adjunct to lumbar fusion surgery.
    • Semi-invasive electrical stimulation for failed lumbar fusion.

    Investigational Cervical Stimulation

    Invasive, semi-invasive, and noninvasive electrical stimulation are considered investigational for either of the following cervical indications.

    ANY of the following

    • Invasive, semi-invasive, or noninvasive electrical stimulation as an adjunct to cervical fusion surgery.
    • Invasive, semi-invasive, or noninvasive electrical stimulation for failed cervical spine fusion.

    Coverage may be considered for invasive or noninvasive electrical bone growth stimulation as an adjunct to lumbar spinal fusion surgery when the patient is at high risk for fusion failure. Noninvasive stimulation may also be considered for failed lumbar spinal fusion. Invasive, semi-invasive, and noninvasive stimulation for cervical fusion surgery or failed cervical spine fusion is investigational.

    Semi-invasive electrical stimulation is investigational as an adjunct to lumbar fusion surgery and for failed lumbar fusion.

    Electrical stimulation is not medically necessary when the applicable coverage criteria are not met.

    Billing Codes and Operational Thresholds

    CPT codes considered medically necessary when applicable criteria are metCPTCovered
    20974Electrical stimulation to aid bone healing; noninvasive (non-operative).
    20975Electrical stimulation to aid bone healing; invasive (operative).
    HCPCS codes considered medically necessary when applicable criteria are metHCPCSCovered
    E0748Osteogenesis stimulator, electrical, non-invasive, spinal applications.
    E0749Osteogenesis stimulator, electrical, surgically implanted.
    Failed Lumbar Fusion Timing
    Minimum postoperative intervalAt least 6 months after the original surgery
    Applies toFailed lumbar spinal fusion
    Required evidenceThe fusion has not healed at the minimum postoperative interval
    Radiographic Evidence
    Observation period3 months
    Evidence typeSerial radiographs
    Purpose

    Authorization, Documentation, and Benefit Requirements

    Prior Authorization

    Verify benefits and obtain prior approval

    Prior approval is required for services outlined in this policy. Verify benefits and authorization under the member’s applicable subscriber contract, employer plan, or benefit documents before providing the service.

    Billing Rule

    Obtain approval for the billed code

    Each listed CPT and HCPCS code requires prior approval when submitted for electrical bone growth stimulation.

    • CPT 20974 — Electrical stimulation to aid bone healing; noninvasive (non-operative).
    • CPT 20975 — Electrical stimulation to aid bone healing; invasive (operative).

    Clinical Background

    Electrical bone growth stimulation may be used as an adjunct to spinal fusion to improve the likelihood of achieving a solid fusion. Evidence supports invasive or noninvasive stimulation for patients at high risk of failed lumbar fusion and noninvasive stimulation for failed lumbar fusion; evidence is insufficient to establish efficacy for cervical fusion surgery or failed cervical fusion.

    Policy Definitions

    Failed Lumbar Spinal Fusion
    DefinitionA lumbar spinal fusion that has not healed at least 6 months after the original surgery
    Required imagingSerial radiographs
    Imaging periodOver a 3-month period
    High Risk for Lumbar Fusion Failure
    Qualification standardAt least one listed risk factor for lumbar fusion failure
    Structural risk factorsOne or more previous failed spinal fusions; grade 3 or worse spondylolisthesis; or fusion planned at more than one level
    Patient-related risk factors
    Policy Summary
    PayerBlue Cross Blue Shield of Vermont
    PolicyElectrical Stimulation of the Spine as an Adjunct to Spinal Fusion Procedures
    Policy CodePolicy 7.01.VT85
    Change TypeNo material change
    Effective DateJan 1, 2026
    Last ReviewSep 1, 2025
    Next Review DateSep 1, 2026
    Key ActionObtain prior approval for each listed CPT and HCPCS code when submitting electrical bone growth stimulation.
    SourceLink
    On This Page
    Medical Necessity and Investigational CriteriaBilling Codes and Operational ThresholdsAuthorization, Documentation, and Benefit RequirementsClinical BackgroundPolicy Definitions
    Evidence that the lumbar spinal fusion remains unhealed
    Spondylolisthesis Risk Threshold
    Spondylolisthesis thresholdGrade 3 or worse
    Risk-factor standardAny one listed high-risk factor qualifies
    Clinical applicationHigh risk for lumbar fusion failure
    Fusion Extent Risk Threshold
    Fusion extent thresholdMore than one level
    Risk-factor standardAny one listed high-risk factor qualifies
    Clinical applicationHigh risk for lumbar fusion failure
  1. HCPCS E0748 — Osteogenesis stimulator, electrical, non-invasive, spinal applications.
  2. HCPCS E0749 — Osteogenesis stimulator, electrical, surgically implanted.
    3. Documentation Required

    Document failed lumbar fusion

    For failed lumbar spinal fusion, document that the fusion has not healed at least 6 months after the original surgery and provide serial radiographs obtained over a 3-month period.

    • Document the minimum 6-month interval after the original surgery.
    • Include serial radiographs demonstrating the unhealed fusion over 3 months.
    Documentation Required

    Record lumbar fusion failure risk factors

    For lumbar fusion surgery, document at least one applicable high-risk factor for fusion failure.

    • One or more previous failed spinal fusions.
    • Grade 3 or worse spondylolisthesis.
    • Fusion to be performed at more than one level.
    • Current tobacco use, diabetes, renal disease, alcoholism, or steroid use.
    Billing Rule

    Confirm provider eligibility

    Services must be furnished by qualified healthcare professionals practicing within the scope of their license(s).

    Denial Risk

    Meet the applicable medical-necessity criteria

    Services are considered not medically necessary when the applicable medical-necessity criteria are not met.

    Denial Risk

    Screen for investigational indications

    Identify investigational indications before requesting or providing stimulation. Semi-invasive electrical stimulation is investigational for lumbar fusion surgery and failed lumbar fusion; invasive, semi-invasive, and noninvasive stimulation are investigational for cervical fusion surgery and failed cervical spine fusion.

    • Lumbar: semi-invasive stimulation used as an adjunct to fusion surgery or for failed lumbar fusion.
    • Cervical: invasive, semi-invasive, or noninvasive stimulation used as an adjunct to fusion surgery or for failed cervical spine fusion.
    Note

    Check member-specific benefit limitations

    Coverage is subject to the member’s contract or benefit plan. If there is a conflict, the member’s contract or employer benefit plan language takes precedence over the medical policy.

    • Verify benefits before providing the service.
    • ASO, Federal Employee Program, and other members may have different benefits or limitations.
    Current tobacco use; diabetes; renal disease; alcoholism; or steroid use
    Semi-Invasive Electrical Stimulation
    DefinitionElectrical stimulation delivered by a method that is neither fully noninvasive nor surgically implanted
    Lumbar useConsidered investigational as an adjunct to lumbar fusion surgery and for failed lumbar fusion
    Cervical useInvasive, semi-invasive, and noninvasive electrical stimulation are considered investigational for cervical fusion surgery and failed cervical spine fusion