CurrentUnitedHealthcarePolicy CS037ID.B

Electrical and Ultrasound Bone Growth Stimulators (for Idaho Only)

State-specific UnitedHealthcare medical policy for Idaho (including Idaho Medicaid Plus) governing clinical coverage references and coding for electrical and low-intensity ultrasound bone growth stimulators. The policy defers medical necessity clinical criteria to the Idaho Medicaid Provider Handbook, Suppliers, Chapter 5.31.

Policy Summary

PayerUnitedHealthcare

PolicyElectrical and Ultrasound Bone Growth Stimulators (for Idaho Only)

Policy CodePolicy CS037ID.B

Change TypeReplaced coverage guidelines; references updated

Effective DateAugust 1, 2025

Next Review Date

Key ActionProviders and medical reviewers must use the Idaho Medicaid Provider Handbook, Suppliers, Chapter 5.31: Osteogenesis Stimulators for medical necessity determinations; UnitedHealthcare defers to that source for clinical coverage criteria.

POLICY UPDATE CHANGES

Replaced coverage guidelines with instruction to refer to the Idaho Medicaid Provider Handbook, Suppliers, Chapter 5.31 for medical necessity clinical coverage criteria.

Updated References section to reflect current information.

1State-specific policy (Idaho)

3Referenced HCPCS/CPT codes

Coverage Summary

This is a state-specific UnitedHealthcare medical policy for Idaho titled Electrical and Ultrasound Bone Growth Stimulators (for Idaho Only) (Policy Number CS037ID.B), effective August 1, 2025.

The policy applies only in the state of Idaho, including Idaho Medicaid Plus plans, and defers medical necessity clinical coverage criteria to the Idaho Medicaid Provider Handbook, Suppliers, Chapter 5.31: Osteogenesis Stimulators; reviewers and providers must use that Idaho Medicaid handbook for clinical coverage determinations.

Key Facts

State-specific policy (Idaho)This policy applies only in the state of Idaho, including Idaho Medicaid Plus plans.

Referenced HCPCS/CPT codesCPT: 20974, 20975, 20979; HCPCS: E0747, E0748, E0749 (use E0748 for all spinal levels)

Application definitionThis Medical Policy only applies the state of Idaho, including Idaho Medicaid Plus plans.

Medical Necessity / Coverage Rationale

Coverage Rationale / Medical Necessity

Medical necessity clinical coverage criteria are governed by the Idaho Medicaid Provider Handbook; UnitedHealthcare directs reviewers to that source.

This Medical Policy applies only in the state of Idaho, including Idaho Medicaid Plus plans.

UnitedHealthcare defers clinical medical necessity determinations to the Idaho Medicaid Provider Handbook, Suppliers, Chapter 5.31: Osteogenesis Stimulators.

For medical necessity clinical coverage criteria, refer to the Idaho Medicaid Provider Handbook, Suppliers, Chapter 5.31: Osteogenesis Stimulators.

Reviewers must use the Idaho Medicaid Provider Handbook for clinical criteria; UnitedHealthcare policy is informational and defers to that source.

Coding

Referenced CPT codesCPT

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).

Referenced HCPCS codes (osteogenesis stimulators)HCPCS

E0747	Osteogenesis stimulator, electrical, noninvasive, other than spinal applications.
E0748	Osteogenesis stimulator, electrical, noninvasive, spinal applications.
E0749	Osteogenesis stimulator, electrical, surgically implanted.

Spine coding clarificationHCPCS

E0748

Utilize HCPCS code E0748 when reporting bone growth stimulation for all anatomical levels of the spine.

Provider Actions / Billing Rules

Documentation Required

Reference Idaho Medicaid clinical criteria

Providers and medical reviewers must use the Idaho Medicaid Provider Handbook, Suppliers, Chapter 5.31: Osteogenesis Stimulators for medical necessity determinations; UnitedHealthcare policy defers to that source for clinical coverage criteria.

Idaho Medicaid Provider Handbook, Suppliers, Chapter 5.31

Billing Rule

Use E0748 for spine

When reporting bone growth stimulation for any spinal anatomical level, bill HCPCS code E0748.

E0748
Bill HCPCS code E0748 for any spinal anatomical level

Background & Regulatory Information

This policy concerns osteogenesis stimulators (electrical and low-intensity ultrasound) and notes that the U.S. Food and Drug Administration regards bone growth stimulators as significant‑risk (Class III) devices; FDA device listings and product codes are provided for informational purposes only.

Revision History

08/01/2025material_changeLatest

Removed prior detailed coverage criteria, definitions (Delayed Union, Electrical Bone Growth Stimulator, Fracture Union, Nonunion Fracture, Ultrasonic Bone Growth Stimulator), medical records documentation, description of services, and clinical evidence sections; archived previous policy version CS037ID.A. Replaced coverage guidelines with instruction to refer to the Idaho Medicaid Provider Handbook, Suppliers, Chapter 5.31 for medical necessity clinical coverage criteria.

non_material_update

Updated References section to reflect current information (Idaho Medicaid Provider Handbook, Suppliers. 5.31. Osteogenesis Stimulators).