Delayed unions of fractures or failed arthrodesis at high-risk sites (e.g., open or segmental tibial fractures, carpal navicular fractures, 5th metatarsal fractures, distal radius, and sesamoid bones (fibular sesamoid in the foot), or Delayed unions of fractures or failed arthrodesis at high-risk sites (e.g., open or segmental tibial fractures, carpal navicular fractures, 5th metatarsal fractures, distal radius, and sesamoid bones (fibular sesamoid in the foot), orA.Direct current electrical bone-growth stimulators, as well as inductive coupling or capacitive coupling non-invasive electrical stimulators for any of the following non-spinal indications:.The two portions of the involved bone are separated by less than 1 centimeter (cm).Bone is stable on both ends by means of cast or fixation and.An ultrasonic osteogenesis stimulator for non-unions, failed arthrodesis, and congenital pseudarthrosis (pseudoarthrosis) of the appendicular skeleton if there has been no X-ray evidence of progression of healing for 3 or more months despite appropriate fracture care, and the following criteria are met:.Fractures on these sites are difficult to heal because of poor vascular supply. This system uses pulsed ultrasound to speed healing. Fresh fractures, fusions, or delayed unions of the distal radius (Colles fracture) treated with closed reduction and cast immobilization.Fresh fractures, fusions, or delayed unions of the 5th metatarsal (Jones fracture) or.Fresh fractures, fusions, or delayed unions of the scaphoid (carpal navicular) or.Fresh closed or grade I Footnotes* open, short oblique or short spiral fractures, fusions, or delayed unions of the shaft (diaphysis) of the tibia that are treated with closed reduction and cast immobilization or.The use of an ultrasonic osteogenesis stimulator (e.g., an ultrasonic accelerated fracture healing device) as durable medical equipment (DME) to accelerate healing of fresh fractures, fusions, or delayed unions at any of the following high-risk sites:.
This Clinical Policy Bulletin addresses bone growth stimulators.Īetna considers the following bone growth stimulators medically necessary:
Number: 0343 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background References
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