Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • 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.

    v1.0.30
    OpenPayerPolicy UpdatesOrthopedics/MusculoskeletalBCBS North Dakota Bone Lengthening Coverage | Open…
    Ask Trek AI about this page
    CurrentBlue Cross Blue Shield - North DakotaPolicy N/A

    Bone Lengthening (Distraction Osteogenesis)

    Customize your policy alerts

    Sign up for all Blue Cross Blue Shield - North Dakota policy alerts

    Know when Blue Cross Blue Shield - North Dakota releases new policies or updates existing guidance.

    Monitor payer policy activity

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

    Coverage of bone lengthening for limb-length discrepancies, limb deformities, nonunion or malunion, amputation stump lengthening, and bone defects when medical-necessity criteria are met; procedures solely to alter short stature are cosmetic.

    Policy Summary
    PayerBlue Cross Blue Shield - North Dakota
    PolicyBone Lengthening (Distraction Osteogenesis)
    Policy CodePolicy N/A
    Change TypeNo material clinical or coverage change
    Effective DateJan 1, 202754d
    Last ReviewAug 1, 2026
    Next Review DateAug 1, 2027
    Key ActionSubmit clinical documentation supporting the applicable criteria, including history and physical or chart notes, relevant imaging, and details of the condition being treated.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    6 cmLeg length discrepancy threshold
    3 months

    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.

    Minimum time since injury or treatment
    2 studiesRequired recent imaging
    13CPT codes listed
    1HCPCS codes listed
    Cosmetic exclusionSolely to alter short stature

    Medical Necessity and Coverage Determinations

    Medically Necessary Bone Lengthening

    Bone lengthening procedures may be considered medically necessary when both Criterion A and Criterion B are met.

    Both criteria required

    • Criterion A: Qualifying primary condition

      • Limb-length discrepancy: Correction of a congenital or post-traumatic limb-length discrepancy.
      • Angular deformity: Correction of an angular deformity of the limb, including the arm, forearm, thigh, or leg.

    • Criterion B: Additional qualifying indication

      • Fracture nonunion or malunion

        • Required timing: At least 3 months have passed since the date of injury or treatment.at least 3 months
        • Radiographic evidence on at least 2 serial imaging studies during the most recent 3-month period shows evidence of nonunion or malunion.at least 2 serial imaging studies during the most recent 3-month period
      • Amputation stump lengthening: Lengthening of an amputation stump is needed to ensure proper fitting of a prosthesis.
      • Leg-length equalization: Bone lengthening is needed to equalize a leg-length discrepancy greater than 6 cm.greater than 6 cm
      • Congenital or post-traumatic deformity correction: Correction of any congenital limb-length discrepancy or post-traumatic angular-rotational deformation of the long bones.
      • Bone defect: Bone lengthening is being used for a bone defect, with or without deformity.

    Medically Necessary

    Bone lengthening may be considered medically necessary when the applicable policy criteria are met.

    Covered indications: The procedure addresses a congenital limb-length discrepancy, a post-traumatic limb-length discrepancy, or correction of an angular deformity of the limb, including the arm, forearm, thigh, or leg.

    Not Medically Necessary

    Bone lengthening is considered not medically necessary when the applicable policy criteria are not met.

    Not medically necessary conditions: The indication is other than a congenital or post-traumatic limb-length discrepancy or correction of an angular deformity of the arm, forearm, thigh, or leg; or the individual does not meet the applicable policy criteria for those indications.

    Short stature without limb-length discrepancy or deformity is addressed separately as cosmetic.

    Cosmetic

    Bone lengthening is cosmetic when performed solely to alter stature.

    Cosmetic use: The sole purpose of treatment is to alter short stature, and there is no limb-length discrepancy or deformity.

    Cosmetic treatment is not medically necessary.

    Bone lengthening performed solely to alter short stature is considered cosmetic.

    Bone lengthening performed solely to alter short stature, in the absence of a limb-length discrepancy or deformity, is considered cosmetic.

    Bone lengthening is not medically necessary for congenital or post-traumatic limb-length discrepancies, or for correction of angular deformities of the arm, forearm, thigh, or leg, when the applicable medical-necessity criteria are not met.

    For all other indications, excluding short stature, bone lengthening is not medically necessary. This also applies to treatment of congenital or post-traumatic limb-length discrepancies and correction of angular deformities of the arm, forearm, thigh, or leg when the individual does not meet the applicable policy criteria.

    Procedure and Qualification Coding

    CPT CodesCPT
    0594TIncision of upper arm bone and insertion of bone-lengthening device in marrow cavity.
    20690Placement of single direction external bone stabilizing device to arm or leg.
    20692Placement of multiple direction external bone stabilizing device to arm or leg.
    20693Revision of external bone stabilizing device under anesthesia.
    20696Placement of multiple direction external bone stabilizing device to arm or leg.
    20697Placement of multiple direction external bone stabilizing device to arm or leg using imaging guidance.
    24420Reconstruction of upper arm bone.
    25391Lengthening of one of the forearm bones with patient-derived bone graft.
    25393Lengthening of both bones of forearm with patient-derived bone graft.
    27458Incision of thigh bone and insertion of bone-lengthening device in marrow cavity.
    1–10 of 13
    1/2
    HCPCS CodesHCPCS
    27715Lengthening or shortening of lower leg bones
    Leg length discrepancy
    Qualifying conditionBone lengthening is needed to equalize a leg length discrepancy.
    Qualification thresholdThe leg length discrepancy must be greater than 6 cm.
    Policy contextLeg length equalization is one of the additional indications under the medical policy criteria.
    Time since injury or treatment
    Applicable conditionFracture nonunion or malunion of a long bone.
    Minimum intervalAt least 3 months must have passed since the date of injury or treatment.

    Documentation and Review Considerations

    Documentation Required

    Required Clinical Documentation

    Submit the clinical records and supporting descriptions needed to determine whether the policy criteria are met.

    • History and physical examination and chart notes
    • Description of the congenital condition, trauma, or angular deformity causing the limb length discrepancy, including the amount of discrepancy
    • For fracture nonunion or malunion: location of the fracture nonunion or malunion; date of injury or previous fracture treatment; and serial radiographs documenting no progressive signs of healing over the most recent three months
    • For lengthening after amputation: description of the length discrepancy and the plan for the post-procedure prosthesis
    Denial Risk

    Medical-Necessity Criteria Not Met

    Bone lengthening is considered not medically necessary when the applicable policy criteria are not met, including for congenital or post-traumatic limb length discrepancies or correction of angular deformities of the arm, forearm, thigh, or leg.

    Bone Lengthening Overview

    Bone lengthening, also known as distraction osteogenesis, is a surgical technique used to lengthen or rebuild bone. The bone is cut, and a device gradually separates the bone ends so that new bone forms in the intervening space over several months. The procedure may be used for limb-length discrepancies, deformities, nonunion or malunion, amputation-stump lengthening, and bone defects.

    Key Terms

    Distraction osteogenesis
    MethodA surgical method used to lengthen or rebuild bone.
    Bone movementAfter the bone is cut, a device slowly moves the bone ends apart.
    New bone formationNew bone grows in the space between the bone ends over time, allowing gradual correction of bone length or position.
    Bone lengthening
    DefinitionA procedure used to lengthen or reconstruct bone.
    Covered clinical usesLimb length discrepancies, limb deformities, nonunion or malunion, amputation stump lengthening, and bone defects.
    Reconstruction purpose
    Policy Summary
    PayerBlue Cross Blue Shield - North Dakota
    PolicyBone Lengthening (Distraction Osteogenesis)
    Policy CodePolicy N/A
    Change TypeNo material clinical or coverage change
    Effective DateJan 1, 202754d
    Last ReviewAug 1, 2026
    Next Review DateAug 1, 2027
    Key ActionSubmit clinical documentation supporting the applicable criteria, including history and physical or chart notes, relevant imaging, and details of the condition being treated.
    SourceLink
    On This Page
    Medical Necessity and Coverage DeterminationsProcedure and Qualification CodingDocumentation and Review ConsiderationsBone Lengthening OverviewKey Terms
    Documentation contextThe condition may be documented with or without bone loss or infection.
    Serial imaging
    Minimum numberAt least 2 serial imaging studies are required.
    TimingThe studies must be performed during the most recent 3-month period.
    Required findingThe radiographic evidence must show evidence of nonunion or malunion.
    • The determination applies when Criterion I is not met and the indication is other than short stature.
    • For individuals who do not meet policy criteria, these procedures have not been shown to improve health outcomes and are considered not medically necessary.
    Denial Risk

    Solely for Short Stature

    Bone lengthening performed solely to alter short stature is considered cosmetic and may be excluded from coverage.

    • Short stature alone is not a covered medical indication under this policy.
    Documentation Required

    Insufficient Supporting Documentation

    It is critical to submit all clinical documentation supporting the applicable criteria. If required records or supporting descriptions are missing, the omission could affect the review and coverage decision.

    • Member contracts contain specific language regarding covered reconstructive services and excluded cosmetic procedures; specific member contract language takes precedence over this medical policy.
    Denial Risk

    Indication or Criteria Not Met

    Coverage may be denied when the individual does not meet the policy criteria or when the indication falls outside the covered categories. For all other indications, excluding short stature, bone lengthening for congenital or post-traumatic limb length discrepancies and correction of angular deformities of the arm, forearm, thigh, or leg is considered not medically necessary.

    • The procedure has not been shown to improve health outcomes when the policy criteria are not met.
    Denial Risk

    Cosmetic Stature Alteration

    Bone lengthening performed solely to alter short stature, in the absence of a limb length discrepancy or deformity, is considered cosmetic and may be excluded from coverage.

    • A documented limb length discrepancy or deformity is required to distinguish a potentially covered indication from cosmetic stature alteration.
    The procedure may be used to rebuild bone as well as to increase bone length.