CMM-603: Electrical and Low Frequency Ultrasound Bone Growth Stimulation (Spine) Guidelines

Covered only when tied to an approved spinal fusion and the patient is high risk for pseudarthrosis (one or more listed risk factors) within 6 months post-op, or as noninvasive treatment for a failed fusion after ≥6 months with imaging showing no healing progression for 3 months; services not meeting these criteria are not medically necessary. Key requirements: documentation of the associated fusion and specific risk factors (e.g., BMI>30, smoking, diabetes, DEXA T‑score ≤‑2.5 within 1 year, multi‑level ≥3 vertebrae, prior failed fusion, etc.), imaging confirmation for failed fusion, prior authorization per CMM‑600.1, and note that semi‑invasive stimulation and low‑intensity ultrasound (and listed indications such as spondylolysis, failed disc arthroplasty, spinal malignancy, or non‑surgical pseudarthrosis) are considered experimental/investigational and excluded.

"Invasive or noninvasive electrical bone growth stimulation performed for an associated approved spinal fusion surgery when BOTH of the following are met: (1) Performed for an associated approved sp..."