SURG.00045 Extracorporeal Shock Wave Therapy

This policy addresses extracorporeal shock wave therapy (ESWT), including Extracorporeal Pulse Activation Therapy (EPAT), for musculoskeletal and soft tissue conditions. Anthem considers ESWT/EPAT investigational and not medically necessary; therefore, it is not covered for these indications and no covered indications are specified. Noncoverage applies to conditions such as chronic plantar fasciitis, calcific tendinitis of the shoulder, chronic lateral epicondylitis (tennis elbow), and elbow tendinitis (e.g., CPT/HCPCS 20999, 28890, 55899, G0279, G0280).

"Use of Extracorporeal Shock Wave Therapy (ESWT), including but not limited to the use of Extracorporeal Pulse Activation Therapy (EPAT®), for the treatment of musculoskeletal conditions and soft t..."

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