A4559 — Coupling gel or paste, for use with ultrasound device, per oz
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- A Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted for the item; claims without a completed SWO shall be denied.
- For DMEPOS base items that require a Written Order Prior to Delivery (WOPD), the supplier must have a signed WOPD before delivering the item; the WOPD may list associated options/accessories/supplies.
- Nonunion of a long-bone fracture must be documented by a minimum of two sets of radiographs obtained prior to starting treatment, separated by at least 90 days, each with multiple views of the fracture site and a treating practitioner’s written interpretation stating no clinically significant evidence of healing between the two sets.
- Proof of delivery (POD) documentation must be maintained by the supplier and made available to the Medicare contractor upon request.
Key Coverage Criteria
- Non-spinal electrical osteogenesis stimulator (HCPCS E0747) is covered for nonunion of a long-bone fracture when there is radiographic evidence that fracture healing has ceased for at least 3 months prior to starting treatment.
- Non-spinal electrical osteogenesis stimulator (HCPCS E0747) is covered for failed fusion of a joint other than the spine when a minimum of 9 months has elapsed since the last surgery.
- Non-spinal electrical osteogenesis stimulator (HCPCS E0747) is covered for congenital pseudarthrosis.
- Spinal electrical osteogenesis stimulator (HCPCS E0748) is covered for failed spinal fusion when a minimum of 9 months has elapsed since the last spinal surgery.
- Spinal electrical osteogenesis stimulator (HCPCS E0748) is covered when used following a multilevel spinal fusion surgery.
- Spinal electrical osteogenesis stimulator (HCPCS E0748) is covered following spinal fusion surgery when there is a history of a previously failed spinal fusion at the same site.
2 Active Policies
L33796 — Osteogenesis Stimulators
J19
AMBETTER-CP.MP.194 — Osteogenic Stimulation
Related Codes
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