Low Intensity Pulsed Ultrasound Fracture Healing Device

This policy covers low‑intensity pulsed ultrasound (LIPUS) fracture healing devices as an adjunct to conventional management to accelerate healing of fresh (<14 days), closed fractures in skeletally mature patients at high risk for delayed healing or nonunion, and for treatment of delayed unions and established nonunions (excluding skull and vertebra), including specific sites such as scaphoid, Jones (proximal fifth metatarsal), metatarsal, distal radius (Colles), and tibial diaphysis. Coverage is limited to adjunctive use with closed reduction and cast immobilization with daily ~20‑minute self‑administration until healing, is restricted to skeletally mature patients and specified indications (not for open fractures, skull/vertebra, stress fractures, congenital pseudarthroses, surgically treated fractures, or arthrodesis), and remains subject to member benefit plan limitations and experimental/investigational exclusions for other uses.

"As an adjunct to conventional management (closed reduction and cast immobilization) for treatment of fresh (<14 days), closed fractures in skeletally mature individuals who are at high risk for del..."