MED.00096 Low-Frequency Ultrasound Therapy for Wound Management

This policy addresses low-frequency, non-contact, non-thermal ultrasound therapy for wound management/debridement, including devices such as MIST/UltraMIST, Qoustic, and SonicOne (reported with CPT/HCPCS 97610). Anthem considers this therapy investigational and not medically necessary, so it is not covered for any indication or application. There are no covered circumstances or exceptions; services billed under 97610 for these devices are excluded from coverage.

"Use of low-frequency, non-contact, non-thermal, ultrasound therapy is consideredinvestigational and not medically necessaryfor all applications."

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