CurrentevicorePolicy CMM-615

Electrical and Low Frequency US Bone Growth Stimulation Spine

Customize your policy alerts

Sign up for evicore Policy CMM-615 alerts

Get alerted when Policy CMM-615 changes without checking for updates manually.

Monitor payer policy activity

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

Defines medical necessity and non-coverage criteria for invasive and non-invasive electrical bone growth stimulation and low-intensity ultrasound for spinal fusion and failed fusion scenarios for plans administered by Cigna/eviCore.

Policy Summary

Payerevicore

PolicyElectrical and Low Frequency US Bone Growth Stimulation Spine

Policy CodePolicy CMM-615

Change TypeNo material change

Effective DateAug 4, 2026

Next Review Date

Key ActionObtain prior authorization and document timing relative to surgery, risk factors for pseudoarthrosis, and imaging showing no progression of fusion over a 3-month period when applicable.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

6Key CPT/HCPCS codes listed

15References cited

6Minimum months post-fusion for failed fusion tx

3Imaging no-progress period

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.

CurrentevicorePolicy CMM-615

Electrical and Low Frequency US Bone Growth Stimulation Spine

Customize your policy alerts

Sign up for evicore Policy CMM-615 alerts

Get alerted when Policy CMM-615 changes without checking for updates manually.

Monitor payer policy activity

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

Policy Summary

Payerevicore

PolicyElectrical and Low Frequency US Bone Growth Stimulation Spine

Policy CodePolicy CMM-615

Change TypeNo material change

Effective DateAug 4, 2026

Next Review Date

Key ActionObtain prior authorization and document timing relative to surgery, risk factors for pseudoarthrosis, and imaging showing no progression of fusion over a 3-month period when applicable.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

6Key CPT/HCPCS codes listed

15References cited

6Minimum months post-fusion for failed fusion tx

3Imaging no-progress period

Multi-level fusion risk threshold

>30BMI risk threshold

Coverage Criteria for Electrical and Ultrasound Bone Growth Stimulation

Associated with an Approved Spinal Fusion Surgery

Covered when ALL of the following are met

Risk factors for fusion failure: Presence of ANY of the following: alcohol use disorder (AUD); Body mass index (BMI) >30; diabetes, renal disease, or other metabolic diseases when bone healing is likely to be compromised; glucocorticoid dependent; Meyerding Grade III or worse spondylolisthesis; multi-level spinal fusion including three (3) or more vertebrae; nutritional deficiency/malnutrition; one or more previously failed spinal fusion(s); osteoporosis or osteopenia (T-score of < -1.0 on a recent [within one year] DEXA); severe anemia; smoking history; immunocompromised status

Treatment for Individuals with Failed Spinal Fusion

Covered when BOTH of the following are met

Failed Spinal Fusion Treatment

Timing: A minimum of six (6) months has passed since the date of the original fusion surgery6 months
Imaging: Serial plain x-rays or appropriate imaging studies confirm there is no evidence of progression of healing/consolidation of the spinal fusion for three (3) months during the later portion of the six (6) month post-fusion surgery period3 months

The policy excludes use of invasive or non-invasive electrical bone growth stimulation in specific clinical situations. Procedures are not medically necessary when performed without meeting the General Guidelines and applicable Indications criteria. Explicit exclusions include acute or chronic lumbar spondylolysis (pars interarticularis defect) (with or without spondylolisthesis), failed cervical or lumbar disc arthroplasty, and spinal malignancy. The policy also excludes use of these modalities as a non-surgical treatment of an established pseudoarthrosis. Additionally, low-intensity ultrasound bone growth stimulation is considered not medically necessary due to insufficient evidence of efficacy.

The policy lists specific uses that are categorized as Experimental, Investigational, or Unproven (EIU) under the Non-Indications section. Clinicians and billing staff should refer to this section when considering indications that are not supported by sufficient evidence or are outside the scope of the policy's approved indications.

When the General Guidelines and applicable Indications criteria are not met, both invasive and non-invasive electrical bone growth stimulation are considered not medically necessary and are subject to denial. The policy explicitly states that procedures performed outside the approved criteria, including the scenarios listed as exclusions, do not meet medical necessity requirements.

Codes, Timing, and Risk Thresholds

Codes referenced in policymixed

20974	Electrical stimulation to aid bone healing; noninvasive (nonoperative)
20975	Electrical stimulation to aid bone healing; invasive (operative)
20979	Low intensity ultrasound stimulation to aid bone healing, noninvasive (nonoperative)
E0748	Osteogenesis stimulator; electrical, noninvasive, spinal applications
E0749	Osteogenesis stimulator; electrical, surgically implanted
E0760	Osteogenesis stimulator; low intensity ultrasound, non-invasive

Covered CPT CodesCPT

20974	Electrical stimulation to aid bone healing; noninvasive (nonoperative)
20975	Electrical stimulation to aid bone healing; invasive (operative)
20979	Low intensity ultrasound stimulation to aid bone healing, noninvasive (nonoperative)

Covered HCPCS CodesHCPCS

E0748	Osteogenesis stimulator; electrical, noninvasive, spinal applications
E0749	Osteogenesis stimulator; electrical, surgically implanted
E0760	Osteogenesis stimulator; low intensity ultrasound, non-invasive

Timing thresholds — inv-07

Non-invasive for at-risk fusionsApplied beginning any time from the time of surgery until up to six (6) months after surgery

Failed fusion — minimum waitA minimum of six (6) months must have passed since the date of the original fusion surgery

Failed fusion — imaging requirementSerial plain x-rays or appropriate imaging must show no progression of healing/consolidation for three (3) months during the later portion of the six (6) month post‑fusion period

Risk thresholds — inv-08

Body mass index (BMI)BMI > 30

Multi-level fusionFusion including three (3) or more vertebrae

Prior Authorization, Documentation, and Billing Guidance

Prior Authorization

Prior authorization required — see CMM‑600.1

Prior authorization requirements apply for use of electrical and low‑intensity ultrasound bone growth stimulation; see CMM‑600.1 for specific timing and documentation requirements.

Follow CMM‑600.1 for submission timing and required supporting documentation.

Billing Rule

Codes listed; prior authorization depends on plan

Codes listed in the policy include CPT 20974, 20975, 20979 and HCPCS E0748, E0749, E0760. Whether prior authorization is required for any listed code depends on the applicable health plan.

20974 — Electrical stimulation to aid bone healing; noninvasive (nonoperative)

Background and Scope

Electrical bone growth stimulation may be applied either invasively (implanted or placed at the time of spinal fusion surgery) or non-invasively (external devices applied postoperatively). Invasive stimulation is intended for placement at the time of the index surgery; non‑invasive stimulation may be used within the first six (6) months after surgery for fusions considered at high risk for pseudoarthrosis and may be used as treatment for established failed fusion only after a minimum of six (6) months from the original fusion surgery with imaging demonstrating no progression of healing for three (3) months. Use is targeted to patients with documented risk factors for fusion failure (for example, BMI > 30, multi-level fusion of three or more vertebrae, or DEXA T-score < -1.0 within one year) and requires appropriate clinical documentation and prior authorization per applicable plan rules.

Definitions and Code Labels

Invasive electrical bone growth stimulation — inv-18

DefinitionInvasive electrical bone growth stimulation refers to electrical bone growth stimulation inserted at the time of the surgery.

Non-invasive electrical bone growth stimulation — inv-19

DefinitionNon‑invasive electrical bone growth stimulation refers to stimulation applied beginning any time from the time of surgery until up to six (6) months after surgery for fusions at risk of failure and after six (6) months for fusions that have failed.

Electrical stimulation to aid bone healing; noninvasive — inv-20

CPT code20974 — Electrical stimulation to aid bone healing; noninvasive (nonoperative)

Policy Summary

Payerevicore

PolicyElectrical and Low Frequency US Bone Growth Stimulation Spine

Policy CodePolicy CMM-615

Change TypeNo material change

Effective DateAug 4, 2026

Next Review Date

Key ActionObtain prior authorization and document timing relative to surgery, risk factors for pseudoarthrosis, and imaging showing no progression of fusion over a 3-month period when applicable.

SourceLink

On This Page

Bone density (DEXA)Osteoporosis or osteopenia with T-score < -1.0 on a recent (within one year) DEXA

20975 — Electrical stimulation to aid bone healing; invasive (operative)

20979 — Low intensity ultrasound stimulation to aid bone healing, noninvasive (nonoperative)

E0748 — Osteogenesis stimulator; electrical, noninvasive, spinal applications

E0749 — Osteogenesis stimulator; electrical, surgically implanted

E0760 — Osteogenesis stimulator; low intensity ultrasound, non‑invasive

Note

Check the member’s health plan for management and payment rules

Refer prior authorization and payment questions to the applicable health plan; the member's Certificate of Coverage or Evidence of Coverage defines coverage terms and conditions.

The inclusion of a code in the table does not imply it is under management or requires prior authorization — check the health plan.
Prior authorization of a listed code is not a guarantee of payment; consult the member’s Certificate of Coverage or Evidence of Coverage.

Denial Risk

Denial risk if criteria not met

Invasive and non‑invasive electrical bone growth stimulation performed without meeting the General Guidelines and Indications criteria are considered not medically necessary and are subject to denial.

Procedures that do not meet the General Guidelines and Indications criteria are considered not medically necessary.
Non‑indicated uses (see Not Medically Necessary section) will be denied.

Documentation Required

Required clinical documentation and timing

Document the timing of therapy relative to the index surgery: invasive devices are placed at the time of surgery; non‑invasive stimulation is applied up to six (6) months post‑op for fusions at risk and only after a minimum of six (6) months for treatment of failed fusion. Also document presence of listed risk factors for pseudoarthrosis and imaging confirming no progression of fusion over a three (3) month interval during the later portion of the six‑month post‑fusion period.

For failed fusion treatment: minimum 6 months since original fusion and serial plain x‑rays or appropriate imaging showing no progression of healing for 3 months.
For associated approved fusion: document any listed risk factors (e.g., BMI >30, multi‑level fusion ≥3 vertebrae, recent DEXA T‑score < -1.0).

Note

Refer to the member’s health plan and coverage documents

Refer to the applicable health plan for specific management details and to the member’s Certificate of Coverage or Evidence of Coverage to determine payment terms.

The Certificate of Coverage or Evidence of Coverage outlines the member’s policy terms and conditions.
Inclusion of a code in this policy table does not, by itself, determine coverage or prior authorization requirements.

Denial Risk

Denial for failure to meet clinical criteria

Procedures that do not meet the General Guidelines and Indications criteria are considered not medically necessary and are subject to denial.

Non‑compliance with the policy’s timing, imaging, or risk‑factor requirements may result in denial.

Note

Code inclusion does not imply authorization or coverage

The inclusion of a code in the Codes table does not imply the code requires prior authorization nor guarantee coverage or payment; check the applicable health plan and the member’s Certificate of Coverage or Evidence of Coverage.

The table lists codes for reference only; plan management decisions determine authorization requirements and payment.

Electrical stimulation to aid bone healing; invasive — inv-21

CPT code20975 — Electrical stimulation to aid bone healing; invasive (operative)

Low intensity ultrasound stimulation; noninvasive — inv-22

CPT code20979 — Low intensity ultrasound stimulation to aid bone healing, noninvasive (nonoperative)

Osteogenesis stimulator; electrical, noninvasive, spinal — inv-23

HCPCS codeE0748 — Osteogenesis stimulator; electrical, noninvasive, spinal applications

Osteogenesis stimulator; electrical, surgically implanted — inv-24

HCPCS codeE0749 — Osteogenesis stimulator; electrical, surgically implanted

Osteogenesis stimulator; low intensity ultrasound — inv-25

HCPCS codeE0760 — Osteogenesis stimulator; low intensity ultrasound, non‑invasive