Currentpriority healthPolicy N/A

OSTEOGENESIS (electrical and ultrasonic stimulators)

Defines coverage, coding, documentation, and billing requirements for electrical and ultrasonic osteogenesis stimulators for Priority Health providers; affects providers submitting claims and Medicare-related cases.

Policy Summary

Payerpriority health

PolicyOsteogenesis (electrical and ultrasonic stimulators)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateAug 25, 2025

Next Review DateN/A

Key ActionObtain a Pre-Service Organization Determination (PSOD) for Medicare indications not meeting NCD/LCD/policy; authorization may be required for place of service.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3HCPCS codes listed

Class IIIDevice classification

KF, KXModifiers required

CMSDocumentation alignment

Coverage conditions and billing requirements

Policy Summary

Payerpriority health

PolicyOsteogenesis (electrical and ultrasonic stimulators)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateAug 25, 2025

Next Review DateN/A

Key ActionObtain a Pre-Service Organization Determination (PSOD) for Medicare indications not meeting NCD/LCD/policy; authorization may be required for place of service.

SourceLink

On This Page

ALL of the following

Written order prior to delivery is present.
Reference CMS standard documentation requirements.
A face-to-face encounter with a physician occurred prior to the written order.
Documentation in the medical record supports medical necessity consistent with this medical policy and CMS standards.

ALL of the following

HCPCS code selection: Select the HCPCS code that aligns to the anatomical site and application documented in the medical record (E0747, E0748, E0749, E0760).
Selecting a code that does not align to the anatomical location and site supported in the medical record will result in a denial.
Devices billed with HCPCS codes E0747, E0748, and E0760 are Class III devices and require the KF modifier appended to all claims submitted with these codes.
When ultrasonic stimulator is used, HCPCS A4559 should be used for ultrasound conductive coupling gel if billed separately.

ALL of the following

Append modifier KF for items designated by FDA as Class III devices when applicable.
Append modifier KX to indicate that the requirements specified in the medical policy have been met.
Modifiers must be applied only when supported by documentation; incorrect application of modifiers will result in denials.

Disposable item billing: If an item or majority component required for functionality is disposable, bill using HCPCS A9270; disposable items do not meet the definition of DME and are not payable as DME.

ALL of the following

For Medicare indications that do not meet NCD, local LCD, or specific medical policy criteria, obtain a Pre-Service Organization Determination (PSOD).
Authorization may be required for services furnished in the appropriate place of service; an authorization does not guarantee payment and does not supersede coding, billing, or documentation requirements.
Refer to provider manual and policy for place-of-service and authorization specifics.

ALL of the following

Devices or services reported without a payable diagnosis or without required documentation will result in denial; failure to follow billing and coding requirements may lead to claim rejection, recoupment, or denial.
Priority Health may perform pre- or post-claim reviews to validate billing and coding accuracy.
Reimbursement is subject to Priority Health fee schedules; authorization alone does not guarantee payment.

HCPCS codes and modifier rules

Osteogenesis stimulator HCPCSHCPCSCovered

E0747	Osteogenesis stimulator, electrical, noninvasive, other than spinal applications
E0748	Osteogenesis stimulator, electrical, noninvasive, spinal applications
E0749	Osteogenesis stimulator, electrical, surgically implanted
E0760	Osteogenesis stimulator, low intensity ultrasound, noninvasive
A4559	Ultrasound conductive coupling gel

Modifier requirements

KF modifierAppend KF to all claims for HCPCS codes E0747, E0748, and E0760 because these osteogenesis devices are classified as FDA Class III.

KX modifierAppend KX to codes when the medical policy criteria are met to indicate policy-level medical necessity.

Anatomical site accuracyEnsure the selected HCPCS code aligns with the anatomical site documented in the medical record; mismatches may result in denial.

Disposable components billingIf the item (or its majority component) is disposable, bill with A9270; disposable items are not payable as DME.

A4559 for gelWhen an ultrasonic osteogenesis stimulator is used, bill ultrasound conductive coupling gel with HCPCS A4559.

Prior authorization and pre-service determinations

Prior Authorization

Pre‑Service Organization Determination (PSOD) and potential authorization

For Medicare indications that do not meet an NCD, local LCD, or a specific medical policy, a Pre‑Service Organization Determination (PSOD) must be completed before services are furnished. Authorization may also be required depending on place of service; consult the Provider Manual for PSOD and authorization procedures.

Complete a PSOD for Medicare cases not meeting NCD/LCD/policy.
Verify and obtain any required authorization based on place of service per the Provider Manual.

Device definitions

Electrical osteogenesis stimulator

DefinitionDevice that delivers electrical stimulation to enhance bone healing; noninvasive versions use an external power source connected to coils or electrodes placed on the skin or over the fracture/fusion site.

Noninvasive applicationExternal power source with coil or electrodes positioned on the skin; can be used over a cast or brace.

Relevant HCPCS codesElectrical stimulators are reported with HCPCS codes such as E0747 (noninvasive, non‑spinal), E0748 (noninvasive, spinal) and may include implanted E0749.

Ultrasonic osteogenesis stimulator

DefinitionDevice that generates low‑intensity, pulsed ultrasound waves over the skin surface at a fracture site to promote bone healing.

Billing guidanceUltrasonic stimulators are reported with HCPCS E0760; ultrasound conductive coupling gel should be billed with HCPCS A4559 when used.

Noninvasive characteristicApplied over the skin at the fracture site; delivers pulsed ultrasound energy externally rather than via implantation.