CurrentUnitedHealthcarePolicy CS037.S

Electrical and Ultrasound Bone Growth Stimulators

UnitedHealthcare medical policy CS037.S governing coverage criteria for invasive and non-invasive electrical bone growth stimulators and low-intensity pulsed ultrasound bone growth stimulators, including indications for spinal fusion adjunct use and treatment of nonunion fractures, excluded states listed in Application.

Policy Summary

PayerUnitedHealthcare

PolicyElectrical and Ultrasound Bone Growth Stimulators

Policy CodePolicy CS037.S

Change TypeApplication and documentation updates; archived prior version

Effective DateDec 1, 2024

Next Review Date

Key ActionDocument radiographic evidence (skeletal maturity, persistent fracture line, fracture gap measurement), surgical history (date of most recent surgical operation), immobilization status, and comorbidities to demonstrate membership in a covered indication.

POLICY UPDATE CHANGES

Application: Idaho and Kansas added to list of states for which this policy does not apply (refer to state-specific policy versions).

Medical Records Documentation Used for Reviews: updated reference link and added language clarifying that benefit coverage is determined by federal, state, or contractual requirements and that documentation may be required but does not guarantee coverage.

Archived previous policy version CS037.R.

2Distinct covered indications (spinal adjunct; fracture nonunion)

multipleCPT/HCPCS codes referenced

severalStates with separate policies

Background: Bone growth stimulators (electrical and ultrasonic) are devices intended to promote bone healing in difficult-to-heal fractures or as adjuncts to spinal fusion. Electrical devices may be invasive (implantable) or non-invasive (external PEMF, capacitive coupling, combined magnetic fields), and ultrasonic devices (LIPUS/UBGS) deliver low-intensity pulsed ultrasound externally to the fracture site. (Effective: 12/01/2024; Last review: 06/01/2025.)

Overall evidence stance: Evidence supports use of postoperative electrical stimulation as an adjunct to spinal fusion in high-risk patients (moderate-quality evidence showing a pooled ~2.5-fold increase in odds of radiographic fusion). LIPUS (UBGS) is supported for treatment of certain long-bone nonunions with pooled heal rates ≈82% in systematic reviews, with heterogeneity across studies. For other indications (electrical or ultrasonic) the evidence is insufficient and use is considered unproven/not medically necessary.

Scope summary: UnitedHealthcare medical policy CS037.S covers invasive and non-invasive electrical bone growth stimulators and low-intensity pulsed ultrasound bone growth stimulators, specifying covered indications (electrical stimulation as adjunct to lumbar spinal fusion in high-risk patients; LIPUS for fracture nonunion meeting defined criteria) and noting excluded states where state-specific policies apply.

Coverage stance: Mixed — specific, evidence-supported indications are covered (electrical adjunct to spinal fusion in high-risk patients; ultrasonic stimulators for defined nonunions); other uses are considered not medically necessary/unproven due to insufficient evidence.

Key stats & thresholds (brief):

- Distinct covered indications: 2 (spinal adjunct; fracture nonunion).

- CPT/HCPCS codes referenced: multiple (examples: CPT 20974/20975/20979; HCPCS E0747/E0748/E0749/E0760).

- States with separate policies: several (policy does not apply to listed states).

Thresholds (policy-specified):

- Fracture persistent without bridging callus duration: >= 3 months for nonunion indication.

- Fracture gap size: <= 1 cm.

- Time since most recent surgical operation for fracture: < 6 months.

Key coverage facts

Distinct covered indications2 (spinal adjunct; fracture nonunion)

Referenced codesCPT 20974, 20975, 20979; HCPCS E0747, E0748, E0749, E0760

States with separate policiesSeveral (e.g., Idaho, Kansas, Indiana, Kentucky, Louisiana, Nebraska, New Jersey, New Mexico, North Carolina, Ohio, Pennsylvania, Tennessee)

Fracture duration threshold>= 3 months

Fracture gap threshold<= 1 cm

Time since most recent surgery threshold< 6 months

Medical‑Necessity Criteria

Electrical Bone Growth Stimulator — Adjunct to Lumbar Spinal Fusion (Medically Necessary)

Covered when ALL of the following are met:

ALL of the following

Increased risk for fusion failure demonstrated by any of the following:
- Device is an Invasive or Non-Invasive spinal Electrical Bone Growth Stimulator (EBGS) used as an adjunct to lumbar spinal fusion surgery
- Radiographic evidence of skeletal maturity
- Previously failed fusion at the same site, when minimum of six months has elapsed since the last surgical procedure>= 6 months since prior surgery
- Comorbid conditions associated with compromised bone healing (e.g., diabetes, obesity, osteoporosis, current tobacco use)
- Spinal fusion performed or to be performed at more than one level as part of a single surgery
- Spondylolisthesis grade II or greater

Ultrasonic Bone Growth Stimulator — Nonunion of Bone Fractures (Medically Necessary)

Covered when ALL of the following are met:

ALL of the following

Radiographic evidence of a persistent fracture line without bridging callus is present for 3 months or more>= 3 months
Fracture gap is less than or equal to 1 cm<= 1 cm
Fracture reduced and immobilized
Less than 6 months have passed since the date of most recent surgical operation< 6 months

Electrical Bone Growth Stimulator — All Other Indications (Not Medically Necessary / Unproven)

Not covered when ANY of the following apply:

ANY of the following

Use of an Invasive or Non-Invasive EBGS for any indication other than adjunct to spinal fusion (insufficient evidence of efficacy and/or safety)

Ultrasonic Bone Growth Stimulator — All Other Indications (Not Medically Necessary / Unproven)

Not covered when ANY of the following apply:

ANY of the following

Use of Ultrasonic Bone Growth Stimulators for indications other than treatment of nonunion of bone fractures (insufficient evidence of efficacy and/or safety)

Provider Actions

Documentation Required

Medical records to support criteria

Document radiographic evidence (skeletal maturity, persistent fracture line, fracture gap measurement), surgical history (date of most recent surgical operation), immobilization status, and comorbidities to demonstrate membership in a covered indication.

Radiographic evidence (skeletal maturity; persistent fracture line; fracture gap measurement)
Surgical history (date of most recent surgical operation; prior failed fusion at same site when ≥ 6 months elapsed)
Immobilization status (fracture reduced and immobilized)
Comorbidities associated with compromised bone healing (e.g., diabetes, obesity, osteoporosis, current tobacco use)

Prior Authorization

Prior authorization implied for covered uses

Policy requires assessment against clinical criteria for coverage; medical records documentation may be required to assess whether the member meets criteria prior to coverage determination.

Assessment against clinical criteria may be required

Billing Rule

Use HCPCS E0748 for spinal noninvasive reporting

Coding clarification: utilize HCPCS code E0748 when reporting bone growth stimulation for all anatomical levels of the spine.

Affected code: E0748
Note: Use E0748 for reporting noninvasive spinal applications at all spinal levels

Background and Supporting Evidence

Devices and interpretation: Bone growth stimulators include non-invasive electrical devices (PEMF, capacitive coupling, combined magnetic fields), invasive implantable electrical current generators, and non-invasive ultrasonic devices (LIPUS/UBGS) applied externally to the fracture or fusion site. The policy interprets the evidence as follows: electrical stimulation has sufficient moderate-quality evidence to support use as an adjunct to spinal fusion in patients at increased risk for fusion failure; the evidence for electrical stimulation in other indications (e.g., non-spinal arthrodesis, fresh fractures) is insufficient. For ultrasonic stimulation, the evidence supports use for certain long-bone nonunions (pooled heal rates ~82%) but is insufficient to support other indications, and heterogeneity across studies and guideline recommendations (e.g., NICE) temper broader acceptance.

Study / Source	Key finding
Akhter et al. 2020 meta-analysis
Electrical stimulation (PEMF, direct current, capacitive coupling) increased the odds of a successful radiographic fusion by 2.5-fold versus control (moderate-quality evidence).
Foley et al. 2008 RCT
PEMF increased fusion rate at 6 months (83.6% vs 68.6%) but the difference was not significant at 12 months; no differences in patient-centered outcomes.
Leighton et al. 2017 systematic review
Pooled heal rate for LIPUS in nonunions approximately 82% (heterogeneity noted); higher (84%) with stricter nonunion definition (>=8 months).

Delayed Union: A fracture that has not healed within the expected time period; does not necessarily mean it will become a nonunion.

Nonunion Fracture: Arrest in healing defined by motion at the fracture site, incomplete progression toward radiographic healing, and persistence of fracture line without bridging callus.

Electrical Bone Growth Stimulator (Non-Invasive): External device generating weak electrical current using pulsed electromagnetic fields, capacitive coupling, or combined magnetic fields.

Electrical Bone Growth Stimulator (Invasive): Implantable current generator surgically placed; electrode implanted within bone fragments; usually functional 6–9 months.

Ultrasonic Bone Growth Stimulator (UBGS / LIPUS): Non-invasive device emitting low-intensity pulsed ultrasound to accelerate bone repair with an external treatment head centered over the fracture.

Revision History

06/01/2025addedLatest

Application: Idaho and Kansas added to list of states for which this policy does not apply (refer to state-specific policy versions).

12/01/2024revised

06/01/2025revisedLatest

12/01/2024archived

Archived previous policy version CS037.R.

OpenPayer

Electrical and Ultrasound Bone Growth Stimulators

Coverage Summary

Medical‑Necessity Criteria

Coding

Provider Actions

Background and Supporting Evidence

Revision History

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