Nonspinal Electrical Bone Growth Stimulation (EBGS)
Electrical stimulation of a non-united fracture is a procedure whereby electrodes are placed either at the fracture site (invasive/operative) (20975) or around the fracture site (noninvasive/non-operative) (20974). Electrical current is delivered to the fracture promoting osteogenesis within the previously non-united fracture.

Both invasive and noninvasive nonspinal electrical bone growth stimulation are eligible for payment in the treatment of a non-united fracture. A non-united fracture is defined as a fracture that has not healed within a minimum of three months of the original fracture.

Noninvasive, nonspinal electrical bone growth stimulation may be considered medically necessary as a treatment of fracture nonunion or congenital pseudoarthrosis in the appendicular skeleton (the appendicular skeleton includes the bones of the shoulder girdle, upper extremities, pelvis and lower extremities). 

The diagnosis of nonspinal fracture nonunion or congenital pseudoarthrosis must meet ALL of the following criteria:

ANY ONE of the following:

• At least three (3) months have passed since the date of the fracture; or
• At least three (3) months since the date of the surgical treatment of the fracture

AND

ALL of the following:

• Serial radiographs have confirmed that no progressive signs of healing have occurred; and
• The fracture gap is one (1) centimeter or less; and
• The patient can be adequately immobilized and is of an age likely to comply with non-weight bearing for fractures of the pelvis and lower extremities.

Nonspinal Electrical Bone Growth Stimulation (EBGS) will be denied as not medically necessary if the preceding criteria are not met.

When the doctor reports electrical stimulation, the claim should be processed under the appropriate code for electrical stimulation (codes 20974-20975). Use of the device is included in the doctor's global allowance for the electrical stimulation (i.e., no separate payment can be made for the device). A participating, preferred, or network provider cannot bill the member for the device itself.

However, if the patient employs the stimulator at home, rental or purchase of the device (code E0747) may be eligible for payment. In this instance, any charges reported by the doctor for electrical stimulation should be denied as not medically necessary.

Re-casting is considered part of the global surgical allowance for the stimulation. Therefore, re-casting is not eligible for separate payment.

See Medical Policy Bulletin E-35 for information on Ultrasound Osteogenesis Stimulator.

EBGS and Spinal Fusion
Electrical bone growth stimulation of the spine may be considered medically necessary as an adjunct to lumbar spinal fusion surgery for members who are considered high-risk for spinal fusion failure when any of the following criteria is met:

• A multiple-level fusion entailing 3 or more vertebrae (e.g., L3 to L5, L4 to S1, etc.), or
• Grade II or worse spondylolisthesis, or
• One or more failed fusions, or
• One or more of the following risk factors for fusion failure are present:
  • gross obesity (BMI greater than 40),
  • current smoking,
  • diabetes,
  • renal disease, or
  • active alcoholism
  • chronic long-term steroid use

Electrical bone growth stimulation is considered not medically necessary as an adjunct to cervical fusion surgery and/or for failed cervical spine fusion.

Invasive EBGS of the spine should be reported under code 20975 and processed in accordance with multiple surgery payment guidelines.

As an adjunct to spinal fusion surgery, noninvasive EBGS can begin within 30 days after the most recent fusion procedure. As a nonsurgical salvage for pseudoarthrosis, EBGS can be applied after a minimum of six months (after surgery) has passed. Noninvasive EBGS of the spine should be reported under code 20974.

However, if the patient employs the stimulator at home, coverage for the rental or purchase of the device (code E0748) is determined according to individual or group customer benefits. In this instance, any charges reported by the doctor for EBGS of the spine should be denied as not medically necessary.

Services that do not meet the criteria of this policy will not be considered medically necessary. A Pennsylvania participating, preferred or network provider cannot bill the member for the denied service unless: (a) the provider has given advance written notice, informing the member that the service may be deemed not medically necessary; (b) the member is provided with an estimate of the cost; and (c) the member agrees in writing to assume financial responsibility in advance of receiving the service. The signed agreement must be maintained in the provider’s records. Out of Network/Non-participating providers and providers located outside of Pennsylvania may be able to bill members if the service is denied.

Place of Service: Outpatient

Bone growth stimulators are typically an outpatient procedure which is only eligible for coverage as an inpatient procedure in special circumstances including, but not limited to, an adjunct to lumbar spinal fusion surgery.

Description

EBGS and Spinal Fusion
Spinal fusion has been used to restore stability in a number of congenital, acquired, and degenerative spinal disorders. Failure to obtain spinal fusion has persisted over the years as a relatively common problem.

Electrical bone growth stimulation (EBGS) of the spine is a procedure which promotes the healing process by applying a direct electrical current to the spine. EBGS of the spine can be performed as an invasive or noninvasive procedure, depending on the needs of the patient.

Invasive EBGS of the spine involves the insertion of a bone stimulation device directly into the area of spinal surgery after the fusion procedure has been completed.

Noninvasive EBGS of the spine is a procedure which involves the use of an external power supply and externally applied coils which generate a current through the site where bone growth is desired.

This medical policy may not apply to FEP. Medical policy is not an authorization, certification, explanation of benefits, or a contract. Benefits are determined by the Federal Employee Program.