ModifiedUnitedHealthcarePolicy CS037NJ.V

Electrical and Ultrasonic Bone Growth Stimulators (for New Jersey Only)

Coverage rules for invasive and non‑invasive electrical and non‑invasive ultrasonic bone growth stimulators for members in the state of New Jersey, including indications, criteria, and coding guidance.

Policy Summary

PayerUnitedHealthcare

PolicyElectrical and Ultrasonic Bone Growth Stimulators (for New Jersey Only)

Policy CodePolicy CS037NJ.V

Change TypeCoverage criteria revisedclarifying language added

Effective DateFeb 1, 2026

Next Review DateN/A

Key ActionObtain and maintain legible medical record documentation that demonstrates the member meets the policy criteria; prior authorization may be required per plan.

SourceLink

POLICY UPDATE CHANGES

Revised coverage criteria for Ultrasonic Bone Growth Stimulators by replacing the criterion requiring 'less than 6 months have passed since the date of most recent surgical operation' with 'less than 6 months have passed since the date of most recent surgical procedure'.

Added language clarifying invasive or non-invasive electrical bone growth stimulators are unproven and not medically necessary for treatment of indications not listed as proven (including stress fractures).

Added language clarifying ultrasonic bone growth stimulators are unproven and not medically necessary for treatment of indications not listed as proven (including stress fractures).

Added detailed medical records documentation expectations used for review and coverage determination.

2device types covered

6ultrasonic criteria required

CPT & HCPCS

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Coverage Criteria

Electrical Bone Growth Stimulator — Spinal fusion adjunct

Covered when ALL of the following are met for invasive or non‑invasive spinal electrical bone growth stimulators:

Spinal EBGS coverage: Radiographic evidence of skeletal maturity

High risk for fusion failure (at least one required): Previously failed fusion at the same site when a minimum of six months has elapsed since the last surgical procedure OR spinal fusion performed or to be performed at more than one level as part of a single surgery OR comorbid conditions associated with compromised bone healing (e.g., diabetes, obesity, osteoporosis, current tobacco use) OR spondylolisthesis grade II or greater

Ultrasonic Bone Growth Stimulator — Nonunion of long bone fractures

Covered when ALL of the following are met for ultrasonic bone growth stimulators:

Ultrasonic NBGS coverage: Fracture gap is less than or equal to 1 cm<=1 cm

Radiographic criteria: Persistent fracture line without bridging callus present for 3 months or more>=3 months

Immobilization status: Fracture reduced and immobilized

Surgical timing: Less than 6 months have passed since the date of most recent surgical procedure<6 months

Exclusions: Fracture is not pathological or associated with malignancy

Skeletal maturity: Radiographic evidence of skeletal maturity

Not Medically Necessary / Unproven Uses

Not medically necessary when specific criteria are not met:

EBGS not covered: Use of invasive or non‑invasive electrical bone growth stimulators for indications other than adjunct to lumbar spinal fusion meeting the specified criteria (including stress fractures)

Policy states unproven and not medically necessary for other indications

Ultrasonic not covered: Use of ultrasonic bone growth stimulators for indications other than nonunion of long bone fractures meeting the listed criteria (including stress fractures)

Policy states unproven and not medically necessary for other indications

Electrical stimulation — spinal fusion (coverage criteria)

Covered when ALL of the following are met per NASS 2025 recommendations:

Electrical stimulation for augmentation of spinal fusion

Procedural risk conditions: Undergoing spinal fusion of 2 or more motion segments (3 vertebrae) OR undergoing a revision spinal fusion.
Patient risk factors: Smoker unable to stop in preparation for fusion OR one or more comorbidities (diabetes; inflammatory arthritis requiring long‑term corticosteroids; immunocompromised states such as chemotherapy/radiation, hypogammaglobulinemia, granulocytopenia, AIDS, chronic granulomatous disease; systemic vascular disease; osteopenia or osteoporosis) OR elderly/debilitated with high surgical risk.

Electrical stimulation — acute spinal fracture (conditional)

Conditionally recommended when ALL of the following are met:

Acute traumatic spinal fracture treatment with electrical stimulation: Patient has an acute traumatic spinal fracture as defined (compression/burst fractures with ≥50% vertebral height loss, associated segmental angulation 5–15%, stable translational deformity on dynamic imaging, without neurologic deficits or impending deficits) OR symptomatic acute spondylolysis without neurologic compression OR acute nontraumatic osteoporotic compression fracture with significant pain >6 weeks without neurologic deficits or pathologic fracture; AND patient is at high risk for pseudarthrosis (see high‑risk criteria) AND treatment duration is 6 months followed by CT to assess osseous union and dynamic imaging to assess translational displacement ≤2 mm and focal angulation ≤5°.6 months treatment then CT

Conditional NASS recommendation; evidentiary support but lack of full consensus.

Ultrasonic bone-growth stimulators — nonunion

Coverage stance and evidence summary for LIPUS/UBGS:

UBGS for long-bone nonunion: Evidence supports use of low‑intensity pulsed ultrasound (LIPUS) for treatment of nonunions of long bones with pooled heal rates reported (~82–84%) in meta‑analyses; better results observed when used as an alternative to surgery and in cases with smaller gap sizes and lower NUSS scores, though additional high‑quality trials are needed and evidence is limited for other indications.

Electrical stimulation for spinal fusion is not indicated for routine primary (index) spinal fusions or single‑motion‑segment fusions in the absence of additional risk factors. The North American Spine Society (NASS) 2025 guidance specifies that electrical stimulation should be reserved for patients who are at high risk for pseudarthrosis/nonunion (for example, multilevel fusion of ≥2 motion segments, revision fusion, active smokers unable to stop, diabetes, inflammatory arthritis on long‑term steroids, immunocompromised states, systemic vascular disease, osteopenia/osteoporosis, or elderly/debilitated patients). Additionally, electrical stimulation is not indicated in the presence of malignancy or active infection.

Ultrasonic bone growth stimulators are limited to treatment of long‑bone nonunions that meet all stated criteria: fracture gap ≤ 1 cm, radiographic persistence of a fracture line without bridging callus for ≥ 3 months, fracture reduced and immobilized, less than 6 months have passed since the most recent surgical procedure, non‑pathological fracture, and radiographic evidence of skeletal maturity. The literature indicates insufficient evidence to support broader indications; guidelines (including NICE) recommend use only within the nonunion indication or under research/ governance arrangements for other indications.

The policy considers the use of invasive or non‑invasive electrical bone growth stimulators for indications other than the covered adjunct to spinal fusion (per criteria) to be unproven and not medically necessary. This includes, but is not limited to, use for stress fractures and other indications not explicitly listed as proven and medically necessary in the policy.

Similarly, ultrasonic bone growth stimulators are unproven and not medically necessary for the treatment of indications outside the specified long‑bone nonunion criteria. The policy explicitly lists stress fractures among examples of indications considered unproven due to insufficient evidence of efficacy and/or safety.

Coding and Key Criteria Values

Applicable CPT and HCPCS Codes (reference)mixed

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)
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

Fracture gap size — key value

Fracture gap sizeLess than or equal to 1 cm

ContextCriterion applies to ultrasonic bone growth stimulator coverage for long-bone nonunion

Source noteExplicit threshold listed in ultrasonic NBGS coverage criteria

Radiographic persistence duration for nonunion — key value

Radiographic persistence durationPersistent fracture line without bridging callus present for 3 months or more

Clinical implicationUsed to define nonunion for ultrasonic stimulator eligibility

Provider Actions and Documentation Requirements

Prior Authorization

Prior Authorization Required

Prior authorization may be required. Confirm benefit coverage and any prior authorization requirements with the member's plan before scheduling services.

Confirm member eligibility and benefits, including state- or contract-specific mandates that may supersede this policy.
Obtain prior authorization when required by the member's plan; lack of required prior authorization may result in claim denial.

Note

Confirm Benefit and Prior Authorization Requirements

Verify plan-specific benefit limitations, medical necessity criteria, and any applicable age, diagnosis, or timing restrictions prior to treatment.

Coverage is determined by federal, state, or contractual requirements and may vary by plan.
In case of conflict, federal, state, or contractual requirements govern coverage determinations.

Background

Bone healing is a complex biological process influenced by fracture characteristics (type, gap size, stability), blood supply and soft tissue integrity, and patient factors such as nutrition, smoking status, diabetes, vascular disease, and medications that impair healing. Devices described in this policy—electrical and ultrasonic bone growth stimulators—are intended to augment the biological healing response and are indicated only where the policy criteria (including skeletal maturity and specific radiographic and clinical thresholds) are met.

Definitions

Delayed Union

DefinitionDelayed Union: A fracture has not healed within the expected time period; does not imply it will become a nonunion.

Clinical distinctionDelayed union indicates slower-than-expected healing but not necessarily an arrested healing process

Source exampleMehmood, 2017 cited in policy definitions

Nonunion Fracture

DefinitionNonunion Fracture: Arrest in the healing process defined by (1) motion at the fracture site, (2) radiographic persistence of the fracture line without bridging callus, and (3) incomplete progression toward radiographic healing with further healing not expected.

Diagnostic featuresRequires clinical and radiographic findings including persistent fracture line and motion at site