Noninvasive electrical bone growth stimulation may be considered medically necessary for the treatment of fracture nonunions or congenital pseudarthrosis in the appendicular skeleton (the appendicular skeleton includes the bones of the shoulder girdle, upper extremities, pelvis, and lower extremities). The diagnosis of fracture nonunion must meet ALL of the following criteria:
at least 3 months have passed since the date of fracture;
serial radiographs have confirmed that no progressive signs of healing have occurred;
the fracture gap is 1 cm or less;
the individual can be adequately immobilized; and
the individual is of an age likely to comply with nonweight bearing for fractures of the pelvis and lower extremities.
Investigational applications of electrical bone growth stimulation include, but are not limited to, delayed union, fresh fracture, stress fractures, immediate postsurgical treatment after appendicular skeletal surgery, arthrodesis, or failed arthrodesis.
Implantable and semi-invasive electrical bone growth stimulators are considered investigational.
