LCD/NCD Portal

L29245 OSTEOGENIC STIMULATION

 

 

02/02/2009

 

 

Indications and Limitations of Coverage and/or Medical Necessity

• Noninvasive Stimulator (procedure code 20974):

o The noninvasive stimulator device is covered only for the following indications:

 Nonunion of long bone fractures

 Failed fusion, where a minimum of nine months has elapsed since the last surgery

 Congenital pseudarthroses

 As an adjunct to spinal fusion surgery for patients at high risk of pseudarthrosis due to previously failed spinal fusion at the same site or for those undergoing multiple level fusion.

• A multiple level fusion involves 3 or more vertebrae (e.g., L3-L5, L4-S1, etc.).

• Invasive (Implantable) Stimulator (procedure code 20975):

o The invasive stimulator device is covered only for the following indications:

 Nonunion of long bone fractures

 As an adjunct to spinal fusion surgery for patients at high risk of pseudarthrosis due to previously failed spinal fusion at the same site or for those undergoing multiple level fusion.

• A multiple level fusion involves 3 or more vertebrae (e.g., L3-L5, L4-S1, etc.).

o Effective for services performed on or after April 1, 2000, nonunion of long bone fractures, for both noninvasive and invasive devices, is considered to exist only when serial radiographs have confirmed that fracture healing has ceased for three or more months prior to starting treatment with the electrical osteogenic stimulator.

o Serial radiographs must include a minimum of two sets of radiographs, each including multiple views of the fracture site, separated by a minimum of 90 days.

• Ultrasonic Osteogenic Stimulators (procedure code 20979):

o Effective for services performed on or after January 1, 2001, ultrasonic osteogenic stimulators are covered as medically reasonable and necessary for the treatment of non-union fractures.

 In demonstrating nonunion of fractures, we would expect:

• A minimum of two sets of radiographs obtained prior to starting treatment with the osteogenic stimulator, separated by a minimum of 90 days.

o Each radiograph must include views of the fracture site accompanied with a written interpretation by a physician stating that there has been no clinically significant evidence of fracture healing between the two sets of radiographs.

• Indications that the patient failed at least one surgical intervention for the treatment of the fracture.

• Non-union fractures of the skull, vertebrae, and those that are tumor-related are EXCLUDED from coverage.

o The ultrasonic stimulator may NOT be used concurrently with other non-invasive osteogenic devices.

o The national NON-COVERAGE policy related to ultrasonic osteogenic stimulators for fresh fractures and delayed unions remains in place.

o Effective for services performed on or after April 27, 2005, ultrasonic osteogenic stimulators are covered as medically reasonable and necessary for the treatment of non-union bone fractures prior to surgery.

 In demonstrating non-union fractures, the following criteria must be met:

• A minimum of 2 sets of radiographs, obtained prior to starting with the osteogenic stimulator separated by a minimum of 90 days.

• Each radiograph set must include multiple views of the fracture site accompanied with a written interpretation by a physician stating that there has been no clinically significant evidence of fracture healing between the 2 sets of radiographs.

 

 

CPT/HCPCS Codes

 

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)

 

 

ICD-9 Codes that Support Medical Necessity

 

For procedure code 20974, the following ICD-9 codes apply:

724.9 OTHER UNSPECIFIED BACK DISORDERS

733.81 MALUNION OF FRACTURE

733.82 NONUNION OF FRACTURE

996.44 PERI-PROSTHETIC FRACTURE AROUND PROSTHETIC JOINT

V45.4* POSTSURGICAL ARTHRODESIS STATUS

 

For procedure code 20975, the following ICD-9 codes apply:

724.9 OTHER UNSPECIFIED BACK DISORDERS

733.81 MALUNION OF FRACTURE

733.82 NONUNION OF FRACTURE

738.4 ACQUIRED SPONDYLOLISTHESIS

756.12 SPONDYLOLISTHESIS CONGENITAL

909.3 LATE EFFECT OF COMPLICATIONS OF SURGICAL AND MEDICAL CARE

996.44 PERI-PROSTHETIC FRACTURE AROUND PROSTHETIC JOINT

V45.4* POSTSURGICAL ARTHRODESIS STATUS

 

For procedure code 20979, the following ICD-9 code applies:

 

733.82 NONUNION OF FRACTURE

* According to the ICD-9-CM book, diagnosis code V45.4 is a secondary diagnosis code and should not be billed as a primary diagnosis.

 

 

Documentation Requirements

• Documentation must support that this service meets the requirements as listed in the "Indications and Limitations of Coverage and/or Medical Necessity" section of the policy.

• This information is normally found in the office/progress notes and/or operative report.

Utilization Guidelines

 

• The ultrasonic method of osteogenic stimulation is generally performed in the residence of the beneficiary.

• Therefore, it would be generally expected to see only one electrical or ultrasonic stimulator service billed per beneficiary per episode of injury.

 

 

Treatment Logic

• Electrical stimulation to augment bone repair can be attained either invasively or noninvasively.

• Invasive devices provide electrical stimulation directly at the fracture site either through percutaneously placed cathodes or by implantation of a coiled cathode wire into the fracture site.

• The power pack for the latter device is implanted into soft tissue near the fracture site and subcutaneously connected to the cathode, creating a self-contained system with no external components.

• The power supply for the former device is externally placed and the leads are connected to the inserted cathodes.

• With the noninvasive device, opposing pads, wired to an external power supply, are placed over the cast. An electromagnetic field is created between the pads at the fracture site.

• An ultrasonic osteogenic stimulator is a non-invasive device that emits low intensity, pulsed ultrasound.

• The ultrasound signal is applied to the skin surface at the fracture location via ultrasound using conductive gel in order to stimulate fracture healing.

 

 

Sources of Information and Basis for Decision

N/A

 

02/02/2009

The official local coverage determination (LCD) is the version on the Medicare coverage database at www.cms.gov/medicare-coverage-database/.

 

AMA CPT / ADA CDT Copyright Statement

CPT codes, descriptions and other data only are copyright 2011 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

 

 

CMS LCD OSTEOGENIC STIMULATION