CurrentUnitedHealthcarePolicy 2026T0561X

Electrical and Ultrasonic Bone Growth Stimulators – Commercial and Individual Exchange Medical Policyopen_in_new

Defines UnitedHealthcare Commercial and Individual Exchange coverage criteria for invasive and non‑invasive electrical bone growth stimulators and low‑intensity pulsed ultrasonic bone growth stimulators, including specific clinical criteria for spinal fusion adjunctive use and for treatment of long-bone nonunion, and lists applicable procedure and HCPCS codes and documentation requirements.

Policy Summary

PayerUnitedHealthcare

PolicyElectrical and Ultrasonic Bone Growth Stimulators – Commercial and Individual Exchange Medical Policyopen_in_new

Policy CodePolicy 2026T0561X

Change TypeTitle change; criteria clarifications and documentation updates

Effective DateFeb 1, 2026

Next Review Date

Key ActionInclude condition requiring procedure, relevant diagnostic imaging reports (evidence of skeletal maturity; size of fracture gap if applicable; presence/absence and grade of spondylolisthesis), history of previous spinal fusion surgery with dates and levels fused, relevant surgical history with dates, physician's treatment plan, and previous treatments tried/failed or contraindicated including dates and reasons for discontinuation.

SourceLink

POLICY UPDATE CHANGES

Title changed (previously 'Electrical and Ultrasound Bone Growth Stimulators').

Added language that use of an invasive or non-invasive electrical bone growth stimulator is unproven and not medically necessary for treatment of all other indications (including stress fractures).

Revised coverage criteria for Ultrasonic Bone Growth Stimulators: replaced '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 documentation items to Medical Records Documentation Used for Reviews for Electrical Bone Growth Stimulators (condition requiring procedure; imaging evidence of skeletal maturity and spondylolisthesis grade if present; physician's treatment plan).

Removed reference link to Medicare Advantage Medical Policy titled 'Electrical Stimulators Coverage Rationale Electrical Bone Growth Stimulators'.

Updated Description of Services, Clinical Evidence, and References sections to reflect current information.

Archived previous policy version 2026T0561W.

2Indications explicitly covered (EBGS spinal adjunctive; UBGS long-bone nonunion)

2Device types discussed (Electrical, Ultrasonic)

5Required clinical criteria elements for UBGS

Coverage Summary

Overview: Bone growth stimulators (electrical and ultrasonic) are intended to promote bone healing in difficult-to-heal fractures or spinal fusions by applying electrical or low-intensity pulsed ultrasound to the fracture or fusion site. Devices may be invasive (implantable) or non-invasive (external), and are indicated only for individuals with radiographic evidence of skeletal maturity.

High-level stance: UnitedHealthcare Commercial and Individual Exchange considers electrical stimulation proven and medically necessary as an adjunct to lumbar spinal fusion in patients at increased risk for fusion failure when specified criteria are met, and considers low-intensity pulsed ultrasonic stimulation (LIPUS) proven and medically necessary for treatment of long-bone nonunion when specific criteria are met. Use of invasive or non-invasive electrical stimulators and ultrasonic stimulators is considered unproven and not medically necessary for all other indications (including stress fractures) due to insufficient evidence.

Device types and payer scope: Device types include invasive electrical bone growth stimulators (implantable current generator with electrodes), non-invasive electrical bone growth stimulators (external PEMF, capacitive coupling, or combined magnetic field devices), and ultrasonic bone growth stimulators (non-invasive LIPUS). This policy defines coverage criteria for UnitedHealthcare Commercial and Individual Exchange plans.

Quick Criteria & Thresholds

Fracture gap<= 1 cm

Persistent fracture line duration>= 3 months

Time since most recent surgical procedure (UBGS)< 6 months

Spondylolisthesis grade (EBGS spinal)>= Grade II

Device types discussedElectrical, Ultrasonic

Medical Necessity Criteria

Electrical Bone Growth Stimulator — Spinal (Invasive or Non-Invasive) — Medically Necessary

Proven and medically necessary as an adjunct to lumbar spinal fusion surgery when ALL of the following are met:

ALL of the following

Increased risk for fusion failure demonstrated by ANY of the following
- 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 last surgical procedure
- Spinal fusion performed or to be performed at more than one level as part of a single surgery

Coding

Covered CPT (reference list provided)CPT

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 – Device Reporting GuidanceHCPCS

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

Provider Actions

Documentation Required

Medical record documentation required for review

Include condition requiring procedure, relevant diagnostic imaging reports (evidence of skeletal maturity; size of fracture gap if applicable; presence/absence and grade of spondylolisthesis), history of previous spinal fusion surgery with dates and levels fused, relevant surgical history with dates, physician's treatment plan, and previous treatments tried/failed or contraindicated including dates and reasons for discontinuation.

Condition requiring procedure
Relevant diagnostic imaging reports (evidence of skeletal maturity; size of fracture gap if applicable; presence/absence and grade of spondylolisthesis)
History of previous spinal fusion surgery with dates and levels fused
Relevant surgical history with dates
Physician's treatment plan
Previous treatments tried/failed or contraindicated, including dates and reasons for discontinuation

Background & Evidence

Device types and intended use: Bone growth stimulators include invasive (implantable) electrical stimulators surgically placed at the fusion site, non-invasive electrical stimulators that deliver pulsed electromagnetic fields or other external electrical coupling, and non-invasive ultrasonic devices that emit low-intensity pulsed ultrasound to a targeted fracture site. They are used to promote bone healing in difficult-to-heal fractures or as an adjunct to spinal fusion.

Invasive vs non-invasive distinction: Invasive electrical stimulators are surgically implanted current generators with electrodes placed at the graft or fusion site and are typically functional for months and may be removed later. Non-invasive electrical stimulators and ultrasonic devices are externally applied and do not require implantation.

Summary of evidence strength: Evidence supports the use of postoperative electrical stimulation as an adjunct to spinal fusion in high-risk patients — systematic review/meta-analysis found moderate-level evidence with approximately a 2.5-fold increase in odds of successful fusion. For ultrasonic LIPUS, systematic reviews and meta-analyses support use in long-bone nonunion with pooled heal rates around ~82% in heterogeneous studies, and criteria-based use is considered medically necessary. For other indications (including stress fractures and most fresh fractures), the evidence is insufficient or does not show consistent efficacy, and use is deemed unproven and not medically necessary.

Reference	Key Finding
Akhter et al. 2020 (systematic review/meta-analysis)	Moderate-level evidence that postoperative electrical stimulation increases odds of successful spinal fusion (~2.5-fold)
ECRI 2024	Noninvasive electrical stimulators can heal non-union tibia fractures but studies at high risk of bias; more RCTs needed
Leighton et al. 2017	Systematic review/meta-analysis supports LIPUS use in nonunion with pooled heal rate ~82% (heterogeneous)
NICE 2018	Guidance states evidence does not show efficacy for LIPUS for fresh fractures at low risk; limited evidence overall

Definitions

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

Fracture Union: The point at which the fractured bone has regained sufficient strength and stiffness to function as a weightbearing structure without external support.

Nonunion Fracture: An arrest in healing 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.

Radiographic evidence of skeletal maturity: Imaging demonstrating closed growth plates (epiphyses fused with the shaft) indicating bone growth is complete.

Invasive Electrical Bone Growth Stimulator: An implantable current generator surgically placed (with electrodes implanted within bone graft fragments) typically functional for months and often removed in a subsequent procedure; used adjunctively with spinal fusion surgery.

Non-Invasive Electrical Bone Growth Stimulator: An external power source that generates a weak electrical current to target sites using pulsed electromagnetic fields, capacitive coupling, or combined magnetic fields.

Ultrasonic Bone Growth Stimulator: A non-invasive device that emits low-intensity pulsed ultrasound to accelerate bone repair; consists of a main unit with treatment head affixed over the fracture site and is programmed to promote accelerated fracture healing.

Revision History

2026-02-01effective date / policy title changeLatest

Title changed (previously 'Electrical and Ultrasound Bone Growth Stimulators').

2026-02-01clarified coverage stance (material)Latest

Added language that use of an invasive or non-invasive electrical bone growth stimulator is unproven and not medically necessary for treatment of all other indications (including stress fractures).

2026-02-01revised coverage criteria for UBGS (material)

Policy Summary

PayerUnitedHealthcare

PolicyElectrical and Ultrasonic Bone Growth Stimulators – Commercial and Individual Exchange Medical Policyopen_in_new

Policy CodePolicy 2026T0561X

Change TypeTitle change; criteria clarifications and documentation updates

Effective DateFeb 1, 2026

Next Review Date

SourceLink

On This Page

Comorbid conditions associated with compromised bone healing (e.g., diabetes, obesity, osteoporosis, current tobacco use)

Spondylolisthesis grade II or greater>= Grade II

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Electrical Bone Growth Stimulator — Other Indications

Unproven and not medically necessary

ALL of the following

Use of invasive or non-invasive electrical bone growth stimulator for all other indications (including stress fractures)

Ultrasonic Bone Growth Stimulator — Nonunion of Long Bone Fractures — Medically Necessary

Proven and medically necessary when ALL of the following are met:

ALL of the following

Fracture gap is less than or equal to 1 cm<= 1 cm
Exact gap threshold specified in policy
Radiographic evidence of a persistent fracture line without bridging callus is present for 3 months or more>= 3 months
Fracture reduced and immobilized
Less than 6 months have passed since the date of most recent surgical procedure< 6 months since most recent surgical procedure
Fracture that is not pathological or associated with malignancy
Radiographic evidence of skeletal maturity

Ultrasonic Bone Growth Stimulator — Other Indications

Unproven and not medically necessary

ALL of the following

Use of ultrasonic bone growth stimulators for all other indications (including stress fractures)

Prior Authorization

Prior authorization implication

Medical records documentation may be required to assess whether the member meets the clinical criteria for coverage; presence of required documentation does not guarantee coverage — refer to the member specific benefit plan.

Billing Rule

Use of HCPCS code E0748 for spinal devices

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

E0748

2026-02-01added documentation itemsLatest

2026-02-01removed reference/linkLatest

Removed reference link to Medicare Advantage Medical Policy titled 'Electrical Stimulators Coverage Rationale Electrical Bone Growth Stimulators'.

2026-02-01updated sectionsLatest

Updated Description of Services, Clinical Evidence, and References sections to reflect current information.

2026-02-01archived prior versionLatest

Archived previous policy version 2026T0561W.