CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Electrical Bone Growth Stimulation of the Appendicular Skeleton — Implantable and Semi-Implantable

This policy governs coverage and medical necessity criteria for implantable and semi-implantable electrical bone growth stimulators used in the appendicular skeleton for BCBSRI members and Medicare Advantage plans, specifying when invasive stimulation (CPT 20975) and related HCPCS are covered or considered not medically necessary.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyElectrical Bone Growth Stimulation of the Appendicular Skeleton — Implantable and Semi-Implantable

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJan 10, 2025

Next Review DateN/A

Key ActionObtain prior authorization for invasive electrical stimulation (CPT 20975) and confirm member-specific benefits before treatment.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

20975, E0749Primary codes

covered with criteriaMedicare Advantage stance

not medically necessaryCommercial stance

~28References

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Medicare Advantage: Covered with criteria

Medicare Advantage invasive stimulator coverage follows CMS NCD and BCBSRI policy when clinical guidelines are met:

Medicare Advantage invasive stimulator coverage: Device (implantable invasive stimulator) is covered when CMS National Coverage Determination criteria are met, including indications such as nonunion of long bone fractures and specified adjunctive use in spinal fusion for patients at high risk of pseudarthrosis (e.g., prior failed fusion or multiple‑level fusion). Serial radiographs as defined by CMS must be provided to establish nonunion.Minimum of 2 sets of radiographs, each with multiple views, separated by at least 90 days

Refer to Prior Authorization of Spinal Procedures for clinical guideline details and prior authorization requirements for CPT 20975

Commercial and Medicare Advantage: Not covered / Not medically necessary

Commercial Products coverage stance:

Commercial Products - Implantable stimulators: Implantable electrical bone growth stimulator (e.g., CPT 20975; HCPCS E0749) is considered not medically necessary for Commercial Products because the evidence is insufficient to determine effects on health outcomes.

CPT 20975 and HCPCS E0749 are listed as not medically necessary for Commercial Products

Semi-invasive stimulators: Semi-invasive (semi‑implantable) electrical bone growth stimulators are not covered for Medicare Advantage Plans and are considered not medically necessary for Commercial Products; no specific CPT/HCPCS code exists for semi‑invasive stimulators and no FDA‑approved device is identified.

No specific CPT/HCPCS code exists for semi‑invasive stimulators

The semi-invasive electrical bone growth stimulator is not covered for Medicare Advantage Plans and is considered not medically necessary for Commercial Products due to insufficient evidence demonstrating effects on health outcomes.

Coverage and payment for services described in this policy are governed by the member's subscriber agreement, member certificate, and/or the employer agreement; policy statements do not guarantee payment. Providers should verify member-specific benefits and prior authorization requirements with the provider call center or applicable benefit documents prior to delivering services.

An implantable electrical bone growth stimulator (including codes 20975 and E0749) is considered not medically necessary for Commercial Products because the evidence is insufficient to determine its effect on health outcomes.

Services determined to be not medically necessary or otherwise non-covered under a member's benefit plan may not be reimbursed and generally may not be charged to the member unless the provider has informed the member and obtained written agreement in advance to continue treatment at the member's expense. Refer to applicable participation and benefit agreements for details.

CPT and HCPCS Coding

Covered CPT Codes (when criteria met for Medicare Advantage)CPTCovered

20975

Electrical stimulation to aid bone healing; invasive (operative)

Covered HCPCS for Medicare AdvantageHCPCSCovered

E0749

Osteogenesis stimulator, electrical, surgically implanted

Not medically necessary (Commercial Products)mixedNot Covered

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

Radiographic interval to establish nonunion

Minimum radiographic setsMinimum of 2 sets of radiographs, each including multiple views of the fracture site

Minimum intervalSets must be separated by a minimum of 90 days

PurposeEstablish nonunion prior to initiating invasive (implantable) electrical stimulation per CMS NCD

Provider Responsibilities and Prior Authorization

Prior Authorization

Prior Authorization Required

Prior authorization is required for invasive electrical stimulation to aid bone healing (CPT 20975). Providers must obtain prior authorization before scheduling or performing this procedure. Refer to the related "Prior Authorization of Spinal Procedures" clinical guidelines for detailed authorization criteria.

Affected code: CPT 20975

Note

Confirm Benefits and Member Eligibility

Verify member-specific benefits and eligibility before providing services. Coverage and payment are determined by the member's subscriber agreement, certificate, and/or employer agreement; these documents supersede this medical policy.

Confirm benefits via the provider call center or the payer benefits/eligibility portal
If a service is deemed not covered, do not bill the member unless you have obtained the member's informed, written agreement to pay out-of-pocket in advance

Billing Rule

Member Financial Responsibility When Service Not Covered

If a service is not covered or is determined not medically necessary for the member, the provider may not charge the member unless the member has been informed and has provided written agreement in advance to accept financial responsibility. Refer to provider participation agreements for applicable conditions.

Providers must obtain written, advance agreement from the member before billing for non-covered or not medically necessary services
Benefits and coverage determinations are member-specific; always verify prior to rendering services

Documentation Required

Radiographic Documentation for Nonunion (Medicare Advantage)

For Medicare Advantage members, radiographic documentation is required to establish nonunion. Serial radiographs must include at least two sets, each with multiple views of the fracture site, separated by a minimum of 90 days, consistent with the CMS National Coverage Determination (NCD).

Indication: nonunion of long bone fractures
Requirement: Minimum of 2 sets of radiographs, multiple views, separated by at least 90 days

Denial Risk

Commercial Coverage Denial

Commercial product coverage: implantable electrical bone growth stimulators (CPT 20975; HCPCS E0749) are considered not medically necessary for Commercial members. Do not bill members for these devices unless a written, advance agreement to accept financial responsibility has been obtained.

Not medically necessary codes (Commercial): CPT 20975, HCPCS E0749
No FDA-approved device code exists for semi-invasive stimulators

Note

Verify Member Benefits and Prior Authorization

Providers should confirm prior authorization requirements and member-specific coverage decisions through the provider call center or the payer's online benefit portal before initiating treatment.

Use the provider call center for authorization status and benefit inquiries
Check the payer's online tools for eligibility and benefit details

Definitions

Appendicular skeleton — bones in scope

Included bonesShoulder girdle

Included bonesArms (humerus, radius, ulna)

Included bonesPelvis

Included bonesLegs (femur, tibia, fibula)

Invasive (implantable) stimulation — definition

DefinitionSurgical implantation of a cathode at the fracture or fusion site with a current generator implanted in an intramuscular or subcutaneous space

Generator managementGenerator typically remains functional for 6–9 months and is often removed in a second procedure

Electrode managementElectrode implanted within bone fragments may or may not be removed after therapy

Semi-invasive (semi-implantable) stimulation — definition

DefinitionPercutaneous electrodes placed into the fracture site with an external power source (avoids surgical removal of a generator)

Regulatory noteNo semi-invasive electrical bone growth stimulator devices with FDA approval or clearance were identified

Coding noteNo specific CPT/HCPCS code exists for semi-invasive stimulators

Electrical bone growth stimulation — modalities and contexts

Modalities referencedPulsed electromagnetic fields (PEMF)

Modalities referencedCapacitive coupling (electric fields)

Modalities referencedImplantable direct-current stimulators (invasive) for nonunions, delayed unions, and adjunctive use in arthrodesis

Clinical contextsUsed in nonunion, delayed union, pseudarthrosis, fractures, and arthrodeses of the appendicular skeleton

OpenPayer

Electrical Bone Growth Stimulation of the Appendicular Skeleton — Implantable and Semi-Implantable

Coverage and Medical Necessity Criteria

CPT and HCPCS Coding

Provider Responsibilities and Prior Authorization

Background and Clinical Context

Definitions