Payer PolicyActive
Non-Spinal Electrical Osteogenesis Stimulator - DME.ST.110.A
EVICORE-DME-42C5078E
EviCore by Evernorth
Effective: November 15, 2024
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Covers HCPCS E0747 non‑spinal electrical osteogenesis stimulators for non‑spinal nonunion fractures with documented lack of healing on repeat imaging, failed non‑spinal surgical joint fusion, or congenital pseudoarthrosis; spinal indications, acute fractures without documented nonunion, and primary fusion procedures are excluded. Key requirements: repeat imaging showing no progress in bone healing or operative/clinical documentation of failed fusion or congenital pseudoarthrosis, plus appropriate coding (E0747).
Coverage Criteria Preview
Key requirements from the full policy
"Appropriate coding for billing: HCPCS E0747 (as listed under HCPCS Codes)"
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