CurrentUnitedHealthcarePolicy CS037.T

Electrical and Ultrasonic Bone Growth Stimulators

Defines UnitedHealthcare medical policy coverage and criteria for electrical (invasive and non-invasive) and ultrasonic bone growth stimulators for fracture nonunion, delayed union, and as adjuncts to spinal fusion; applies to members except where state-specific policies supersede.

Policy Summary

PayerUnitedHealthcare

PolicyElectrical and Ultrasonic Bone Growth Stimulators

Policy CodePolicy CS037.T

Change TypeNo material changes

Effective DateFeb 1, 2026

Next Review Date

Key ActionVerify benefit coverage and authorization requirements for procedures/devices billed with listed CPT/HCPCS codes prior to submission.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

spine adjunct indicationEBGS spine adjunct

nonunion criteriaLIPUS long-bone nonunion

E0748Spinal HCPCS

NASS 2025Guideline

Coverage Criteria

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Electrical Bone Growth Stimulator — Spinal fusion (proven, medically necessary)

Covered when ALL of the following are met

Lumbar spinal fusion adjunct criteria: Radiographic evidence of skeletal maturity; AND increased risk for fusion failure demonstrated by any of: previously failed fusion at the same site (minimum of 6 months since last surgical procedure), fusion performed or to be performed at more than one level in a single surgery, or comorbid conditions associated with compromised bone healing (e.g., diabetes, obesity, osteoporosis, current tobacco use); AND instruction-for-use indication of spondylolisthesis grade II or greater.

Applies to invasive or non-invasive spinal electrical bone growth stimulators as adjunct to lumbar fusion

Ultrasonic Bone Growth Stimulator — Long-bone nonunion (proven, medically necessary)

Covered when ALL of the following are met

Ultrasonic nonunion criteria: Fracture gap <= 1 cm; AND radiographic evidence of a persistent fracture line without bridging callus for >= 3 months; AND fracture is reduced and immobilized; AND less than 6 months have passed since the date of the most recent surgical procedure; AND fracture is not pathological or associated with malignancy; AND radiographic evidence of skeletal maturity.

Non-invasive ultrasonic stimulation (LIPUS) indicated only when all criteria are fulfilled

Ultrasonic exclusion: Use is unproven and not medically necessary for all other indications including stress fractures.

Use of electrical or ultrasonic bone growth stimulators for indications other than those specifically listed in this policy (including stress fractures) is considered unproven and not medically necessary due to insufficient evidence of efficacy and/or safety. This applies to both invasive and non‑invasive electrical stimulators and to ultrasonic (LIPUS) devices when used outside the covered indications described below.

Providers should expect that requests for these off‑label or non‑specified indications may be denied and that medical records will be reviewed to determine whether the specific coverage criteria in this policy are met.

Electrical stimulation as an adjunct to spinal fusion is a covered indication only when the member meets the policy's specific high‑risk criteria (for example, revision fusion, multilevel fusion, or comorbidities associated with compromised bone healing). Conversely, electrical stimulation is not indicated for routine primary (index) spinal fusions without additional risk factors or for single‑motion‑segment (one‑level) fusions in the absence of qualifying risk factors.

Per guideline recommendations, electrical stimulation of spinal fusion is also not indicated in the presence of malignancy or infection. When criteria for the adjunct to lumbar fusion indication are not met, use of invasive or non‑invasive electrical stimulators for spinal fusion is considered unproven and not medically necessary.

Invasive or non‑invasive electrical bone growth stimulators are unproven and not medically necessary for treatment of indications other than as an adjunct to lumbar spinal fusion when the policy criteria for that indication are satisfied. This determination is based on insufficient evidence of efficacy and/or safety for other uses, including use for fracture types or clinical scenarios not specified as covered in this policy.

Ultrasonic bone growth stimulators (low‑intensity pulsed ultrasound) are considered proven and medically necessary only for the treatment of nonunion of long‑bone fractures when all of the policy criteria are met (e.g., fracture gap ≤ 1 cm; persistent fracture line without bridging callus ≥ 3 months; fracture reduced and immobilized; less than 6 months since most recent surgical procedure; fracture not pathological or associated with malignancy; radiographic evidence of skeletal maturity).

Use of ultrasonic bone growth stimulators for any other indications, including stress fractures, is unproven and not medically necessary due to insufficient evidence of benefit.

Coding and Key Parameters

Procedure CPT Codes referencedCPT

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)

HCPCS CodesHCPCS

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

inv-09: Fracture gap — <= 1 cm

ThresholdFracture gap less than or equal to 1 cm

ContextCriterion for use of ultrasonic (LIPUS) bone growth stimulator in long‑bone nonunion

Related requirementApplies when all other nonunion criteria are also met (persistent fracture line >=3 months, reduced/immobilized fracture, <6 months since surgery)

inv-10: Persistent fracture line without bridging callus duration — >= 3 months

ThresholdRadiographic evidence of a persistent fracture line without bridging callus present for 3 months or more (>= 3 months)

ContextRequired radiographic finding for long‑bone nonunion when evaluating ultrasonic (LIPUS) stimulator eligibility

Related requirementMust be present alongside fracture gap <=1 cm, immobilization, <6 months since surgery, non‑pathological fracture, and skeletal maturity

inv-11: Time since most recent surgical procedure — < 6 months

ThresholdLess than 6 months have passed since the date of the most recent surgical procedure (< 6 months)

ContextTime window requirement for ultrasonic (LIPUS) treatment of long‑bone nonunion

Related requirementFracture must also be reduced and immobilized and not pathological; skeletal maturity required

Provider Actions and Requirements

Prior Authorization

Prior Authorization Required

Authorization for listed CPT/HCPCS codes — Prior authorization is implied for procedures/devices billed with the listed CPT/HCPCS codes; providers should verify benefit coverage and authorizations with UnitedHealthcare before scheduling services.

Affected codes: CPT 20974, 20975, 20979; HCPCS E0747, E0748, E0749, E0760
Utilize HCPCS E0748 when reporting bone growth stimulation for all anatomical levels of the spine.

Denial Risk

Clinical Indication Restriction

Use of invasive or non-invasive electrical bone growth stimulators is considered medically necessary only as an adjunct to lumbar spinal fusion when specific clinical criteria are met (skeletal maturity and increased risk for fusion failure such as prior failed fusion ≥6 months, multilevel fusion, or comorbid conditions compromising bone healing). Use for other indications is unproven and not medically necessary.

Invasive and non-invasive spinal electrical stimulators: covered as adjunct to lumbar fusion only when criteria met
Use for indications other than adjunct to spinal fusion (including stress fractures) is unproven/not medically necessary

Documentation Required

Documentation May Be Required

Medical records documentation may be required to assess whether the member meets the clinical criteria for coverage. Submission of documentation does not guarantee payment; include operative reports, imaging reports showing radiographic findings, and documentation of comorbid conditions or prior fusion when applicable.

Include radiographic evidence of skeletal maturity and relevant imaging demonstrating nonunion or fusion status
Provide documentation of increased risk for fusion failure (e.g., prior failed fusion with date, levels of fusion, comorbidities such as diabetes, obesity, osteoporosis, tobacco use)
For ultrasonic stimulators used for long-bone nonunion, include imaging showing persistent fracture line ≥3 months and fracture gap ≤1 cm

Billing Rule

Billing/Coding Notes

Billing/Coding guidance — Use the CPT and HCPCS codes associated with the device and indication. Listing a code in the policy does not guarantee coverage; verify member benefits. Use HCPCS E0748 for spinal applications and report the appropriate CPT/HCPCS code for invasive versus noninvasive devices.

CPT: 20974 (noninvasive electrical stimulation), 20975 (invasive electrical stimulation), 20979 (low intensity ultrasound)
HCPCS: E0747 (noninvasive nonspinal), E0748 (noninvasive spinal), E0749 (surgically implanted), E0760 (low intensity ultrasound)

Denial Risk

Ultrasonic Stimulator Indications

Use of ultrasonic bone growth stimulators is proven and medically necessary for nonunion of long-bone fractures when specific criteria are met (fracture gap ≤1 cm, persistent fracture line ≥3 months, immobilized and reduced fracture, <6 months since most recent surgery, non-pathologic, skeletal maturity). Use for other indications (including stress fractures) is unproven and not medically necessary.

For long-bone nonunion only: document fracture gap, duration of nonunion, immobilization status, and absence of malignancy/pathologic fracture

Background

Bone healing depends on patient factors such as blood supply, comorbidities (for example, diabetes, obesity, osteoporosis), smoking status, and nutritional status, as well as fracture characteristics including comminution and displacement and the presence of infection. Bone growth stimulators (electrical or ultrasonic) are intended to promote healing in difficult fractures or to augment spinal fusion and are indicated only in skeletally mature individuals.

Clinical coverage in this policy is limited to: (1) electrical stimulators as an adjunct to lumbar spinal fusion when radiographic evidence of skeletal maturity and qualifying increased risk for fusion failure are present (for example, prior failed fusion with ≥ 6 months since the last procedure, multilevel fusion, or relevant comorbidities); and (2) ultrasonic stimulators for long‑bone nonunion when the policy’s detailed criteria (including fracture gap ≤ 1 cm, persistent fracture line ≥ 3 months, and less than 6 months since most recent surgery) are all satisfied.

Definitions

inv-18: Electrical Bone Growth Stimulator — definition and device description

DefinitionElectrical Bone Growth Stimulator: a device (implanted or worn externally) that uses an electric field or current to stimulate bone growth.

Invasive device descriptionImplantable current generator surgically placed with electrode(s) implanted at the targeted fusion site; typically functional for 6–9 months and often removed in a second procedure; used as an adjunct to spinal fusion and implanted at time of surgery.

Non‑invasive device descriptionExternal power source generates a weak electrical current to target sites using pulsed electromagnetic fields, capacitive coupling, or combined magnetic fields; device is worn externally rather than implanted.

inv-19: Ultrasonic (LIPUS) Bone Growth Stimulator — definition and device description

DefinitionUltrasonic (LIPUS) Bone Growth Stimulator: a non‑invasive device that emits low‑intensity pulsed ultrasound to accelerate bone repair.

Device descriptionCharacterized by a main operating unit with external power supply connected to a treatment head module affixed to a mounting fixture and centered over the fracture site; specifically programmed to promote accelerated fracture healing.

Use caseIntended to be applied over the fracture site in cases of long‑bone nonunion when specified radiographic and clinical criteria are met.

inv-20: Nonunion Fracture — Defined by motion at the fracture site, persistent fracture line without bridging callus, and lack of progression toward radiographic hea...

DefinitionNonunion Fracture: an arrest in the healing process defined by motion at the fracture site, radiographic persistence of the fracture line without bridging callus, and incomplete progression toward radiographic healing in the expected time with further healing not expected.

Radiographic criterionPersistence of the fracture line without bridging callus is a required radiographic finding for diagnosing nonunion.

Clinical signMotion at the fracture site is a defining clinical feature of nonunion.

Temporal/expectation elementLack of expected progression toward radiographic healing for the bone and expectation that further healing will not occur without intervention.