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Extracorporeal Shock Wave Therapy (ESWT) for Muscoloskeletal Conditions and Soft Tissue Wounds 2.01.31
Effective date
Mar 19, 2026
Identified
Jun 20, 2026
Summary
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.
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What to do
Action · 6 steps
01Requirements for billing these services: Treat ESWT for the musculoskeletal conditions and wound-healing uses in this policy as investigational, including CPT 0101T, 0102T, 0512T, 0513T, and 28890, which are listed as (E/I).
02Services are contract dependent; if a product does not cover a service, the medical policy criteria do not apply.
03If a commercial product (including an Essential Plan or Child Health Plus product) covers a specific service, the medical policy criteria apply to the benefit.
04If a Medicaid product covers a specific service and there are no New York State Medicaid guidelines (eMedNY) criteria, the medical policy criteria apply to the benefit.
05If a Medicare product (including Medicare HMO-DSNP) covers a specific service and there is no national or local Medicare coverage decision for the service, the medical policy criteria apply to the benefit.
06If a Medicare HMO-DSNP product does not cover a specific service, refer to the Medicaid product coverage line.
Codes mentioned
28890
Original notice
Extracorporeal Shock Wave Therapy (ESWT) for Muscoloskeletal Conditions and Soft Tissue Wounds 2.01.31
excellusbcbs.com · Always check the source before changing claims.