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28890

PAYER POLICY CHANGES

28890 Insurance Policy Changes

CPT 28890, in plain terms, covers High-energy extracorporeal shock wave therapy to the plantar fascia by a physician, with ultrasound guidance, requiring anesthesia other than local. CPT 28890 is referenced in 11 tracked payer policy changes from UnitedHealthcare, Excellus BlueCross BlueShield, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 28890 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 28890 on AAPC

UnitedHealthcare · Effective Oct 1, 2026High impact
Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions and Soft Tissue Indications (for North Carolina Only)
UnitedHealthcare Community Plan (Medicaid) in North Carolina has updated its ESWT policy effective October 1, 2026, adding notation that CPT codes 0101T, 0102T, 0512T, 0513T, 0864T, and 28890 are NOT on the NC Medicaid Fee Schedule and therefore may not be covered. Billing teams must immediately identify and flag claims using these codes for NC Medicaid patients, as they will likely be denied.
Excellus BlueCross BlueShield · Effective Mar 19, 2026Medium impact
Extracorporeal Shock Wave Therapy (ESWT) for Muscoloskeletal Conditions and Soft Tissue Wounds 2.01.31
Extracorporeal shock wave therapy (ESWT) for musculoskeletal conditions, including chronic plantar fasciitis, tendinitis of the shoulder and elbow, and non-union of fractures, is considered investigational. ESWT as a treatment for wound healing is also considered investigational. The FDA regulates ESWT devices, and ESWT is not addressed in National or Regional Medicare coverage determinations.
Aetna · Identified Oct 2, 2026Medium impact
Extracorporeal Shock-Wave Therapy for Musculoskeletal Indications and Soft Tissue Injuries (CPB 0649, reviewed 2026-09-14)
Aetna clinical policy bulletin 0649 (reviewed September 14, 2026) considers extracorporeal shock-wave therapy medically necessary only for calcific tendinopathy of the shoulder that has lasted at least 6 months, has a calcium deposit of 1 cm or more, and has not responded to conservative care. It lists many other musculoskeletal, pain, wound and scar indications as experimental or not covered. The source gives a review date but no effective date, so confirm current applicability before changing workflows.
Aetna · Identified Aug 13, 2026Medium impact
Plantar Fasciitis Treatments (CPB 0235, reviewed 2026-04-27)
Aetna considers combined steroid/anesthetic injection medically necessary for the treatment of plantar fascia when conservative treatments (such as stretching exercises, over-the-counter silicone heel shoe inserts, and 2 to 3 weeks of non-steroidal anti-inflammatory drugs) have failed. Endoscopic plantar fasciotomy is considered medically necessary as an alternative to conventional open plantar fasciotomy for members with intractable plantar fasciitis or heel spur syndrome who have failed a 6-month trial of conservative therapy. Aetna considers a list of other approaches experimental, investigational or unproven for plantar fasciitis, including extracorporeal shock-wave therapy (ESWT), botulinum toxin, dry needling, Graston technique, low-level laser therapy, platelet-rich plasma and hyaluronic acid.
Aetna · Identified Aug 13, 2026Medium impact
Dupuytren's Contracture Treatments (CPB 0800, reviewed 2025-11-20)
For commercial medical plans, Aetna considers the following medically necessary for Dupuytren's contracture: collagenase clostridium histolyticum (Xiaflex, see CPB 1061), intralesional glucocorticoid injection in early-stage disease, ortho-voltage radiation for early-stage stage N and N/I disease, and percutaneous needle aponeurotomy when criteria are met. Percutaneous needle aponeurotomy is medically necessary for adults with a finger flexion contracture that has a palpable cord in a metacarpophalangeal or proximal interphalangeal joint, a contracture of at least 20 degrees, and a positive table top test, meaning the affected finger or fingers and the palm cannot be placed flat on a table at the same time. Aetna considers treatments such as anti-tumor necrosis factor therapy, autologous fat grafting, extracorporeal shock wave therapy, night-time splinting after fasciectomy or dermofasciectomy, the Digit Widget, and ultrasound therapy experimental, investigational, or unproven.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Extracorporeal Shock Wave Treatment for Plantar Fasciitis and Other Musculoskeletal Conditions
Extracorporeal shock wave therapy, whether high-dose, low-dose or radial, is considered investigational for musculoskeletal conditions including plantar fasciitis, tendinitis of the shoulder, elbow, Achilles and patellar tendons, spasticity, stress fractures, delayed union and nonunion of fractures, and avascular necrosis of the femoral head. Shock wave therapy for salivary stones is investigational, while shock wave therapy for kidney stones is considered eligible for coverage. The Federal Employee Program may dictate that FDA-approved devices are not considered investigational and may be assessed only on the basis of medical necessity.
Independence Blue Cross · Identified Jun 19, 2026Medium impact
MA11.087c, Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions
Independence Blue Cross has reissued Medical Policy MA11.087c confirming that Extracorporeal Shock Wave Therapy (ESWT) for all musculoskeletal conditions remains experimental/investigational and is NOT covered under Medicare Advantage plans. This is a reissue with no substantive changes to coverage status—ESWT claims will continue to be denied for all diagnoses and all protocol types (high-dose, low-dose, or radial).
Aetna · Identified Aug 15, 2026Low impact
Extracorporeal Shock-Wave Therapy for Musculoskeletal Indications and Soft Tissue Injuries (CPB 0649, reviewed 2025-10-02)
This is Aetna Clinical Policy Bulletin 0649, reviewed October 2, 2025 and first found by PolicyChanges in August 2026, so it is historical material and the current version should be confirmed before acting. Aetna covers extracorporeal shock-wave therapy only for calcific tendinopathy of the shoulder with a calcium deposit of at least 1 cm lasting 6 months or more after conservative care has failed, and lists dozens of other musculoskeletal, wound and medical uses as experimental, investigational or unproven.
Independence Blue Cross · Identified Jun 19, 2026Low impact
MA11.087c, Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions
Independence Blue Cross has reissued MA11.087c with no substantive changes to the policy. ESWT for all musculoskeletal conditions remains experimental/investigational and is NOT covered under Medicare Advantage plans. This is a routine annual review reissuance with no new coverage criteria or billing changes.
Independence Blue Cross · Identified Jun 19, 2026Low impact
11.14.13h, Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions
Independence Blue Cross has reissued Policy 11.14.13h confirming that Extracorporeal Shock Wave Therapy (ESWT) for musculoskeletal conditions remains experimental/investigational and NOT COVERED for all diagnoses and all musculoskeletal applications. This is a reaffirmation of existing policy with no substantive changes—the most recent reissuance occurred on 03/04/2026 as part of the annual review process.
Independence Blue Cross · Identified Jun 19, 2026Low impact
11.14.13h, Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions
This is a routine annual reissue of Independence Blue Cross policy 11.14.13h with no substantive changes to coverage. ESWT for musculoskeletal conditions remains non-covered (experimental/investigational) across all diagnoses and protocols. The policy was last reviewed on 03/04/2026 and continues to apply the same exclusion that has been in effect since the original 01/01/2022 effective date.

Watch 28890

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REFERENCE DATA

Payers with rules7

Payers requiring prior auth7

Anthem BCBS · Effective November 1, 2026
Prior authorization required
Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial)
BCBS Illinois · Effective October 1, 2026
Prior authorization required in some cases
Blue Cross Community Health Plans (Illinois Medicaid) Prior Authorization Code List
BCBS New Mexico · Effective October 1, 2026
Prior authorization required
Medicare Advantage Prior Authorization Procedure Code List

FREQUENTLY ASKED QUESTIONS

Does Anthem BCBS require prior authorization for 28890?

Anthem BCBS lists 28890 on Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial) for commercial plans (list dated November 1, 2026). Verify with the payer before scheduling.

Does BCBS Illinois require prior authorization for 28890?

BCBS Illinois lists 28890 on Blue Cross Community Health Plans (Illinois Medicaid) Prior Authorization Code List for medicaid managed plans, with conditions (list dated October 1, 2026). Verify with the payer before scheduling.

Does BCBS New Mexico require prior authorization for 28890?

BCBS New Mexico lists 28890 on Medicare Advantage Prior Authorization Procedure Code List for medicare advantage plans (list dated October 1, 2026). Verify with the payer before scheduling.

Does BCBS Texas require prior authorization for 28890?

BCBS Texas lists 28890 on Medicare Advantage Prior Authorization Procedure Code List for medicare advantage plans (list dated October 1, 2026). Verify with the payer before scheduling.

Does CalViva Health require prior authorization for 28890?

CalViva Health lists 28890 on CalViva Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

What insurance policy changes affect CPT 28890?

There are 11 tracked policy changes affecting CPT 28890, including updates from UnitedHealthcare, Excellus BlueCross BlueShield, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 28890?

Payers that have issued tracked updates for CPT 28890 include: UnitedHealthcare, Excellus BlueCross BlueShield, Aetna, Blue Cross & Blue Shield of Mississippi, Independence Blue Cross.

How do I get notified when CPT 28890 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 28890. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for CPT 28890?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

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Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 28890 in one place.

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All billing codes J3590 C9399 J3490 99215 99213 99202

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Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions and Soft Tissue Indications (for North Carolina Only)

Extracorporeal Shock Wave Therapy (ESWT) for Muscoloskeletal Conditions and Soft Tissue Wounds 2.01.31

Extracorporeal Shock-Wave Therapy for Musculoskeletal Indications and Soft Tissue Injuries (CPB 0649, reviewed 2026-09-14)

Plantar Fasciitis Treatments (CPB 0235, reviewed 2026-04-27)

Dupuytren's Contracture Treatments (CPB 0800, reviewed 2025-11-20)

Extracorporeal Shock Wave Treatment for Plantar Fasciitis and Other Musculoskeletal Conditions

MA11.087c, Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions

Extracorporeal Shock-Wave Therapy for Musculoskeletal Indications and Soft Tissue Injuries (CPB 0649, reviewed 2025-10-02)