Clinical Policy: Osteogenic Stimulation
Defines medical necessity criteria for noninvasive electrical, invasive electrical (implantable), and low-intensity pulsed ultrasound (LIPUS/ultrasonic) osteogenic stimulators for fracture nonunion, delayed union, selected fresh fractures at high risk, and as adjuncts to spinal fusion. Also lists non-covered/ not medically necessary indications and coding implications.
06/25 revision updated criteria formatting and moved/renumbered criteria without impact to clinical criteria; references reviewed and updated.
Added HCPCS code E0760 to coding implications in prior revisions (historical).
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