CurrentUnitedHealthcarePolicy CS041NM.C
Extracorporeal Shock Wave Therapy Nm Cs
UnitedHealthcare Community Plan Medical Policy (New Mexico only) addressing coverage determination and clinical evidence for extracorporeal shock wave therapy (ESWT) for musculoskeletal conditions and soft tissue indications; excludes ESWL for stones. This part (1 of 3) contains coverage rationale, description, and condition-specific evidence summaries.
Policy Summary
PayerUnitedHealthcare
PolicyExtracorporeal Shock Wave Therapy Nm Cs
Policy CodePolicy CS041NM.C
Change TypeTitle change; evidence and references updated
Effective DateNov 1, 2025
Next Review Date
Key ActionApply this medical policy only for members in New Mexico; verification of state plan applicability is required before determining coverage.
SourceLink
POLICY UPDATE CHANGES
Title changed and clinical evidence and references updated in the 11/01/2025 policy history entry.
Title change from 'Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions' and previous New Mexico soft tissue wounds wording.
Updated supporting information and clinical evidence and references sections to reflect the most current information.
0Covered Indications (musculoskeletal/soft tissue)
1State-specific policy (New Mexico only)
6Procedure codes listed (informational)