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Blue Cross & Blue Shield of MississippiAll Plans · Coverage · Medical Policy · Orthopedics, Podiatry, Sports Medicine +1 moreMedium impact

Extracorporeal Shock Wave Treatment for Plantar Fasciitis and Other Musculoskeletal Conditions

Effective date
Not stated in the notice
Identified
Jun 20, 2026

Summary

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.

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What to do

Action · 4 steps
01Billing team: Do not bill extracorporeal shock wave therapy for plantar fasciitis, tendinopathies, spasticity, stress fractures, delayed union or nonunion, or avascular necrosis of the femoral head as covered care, because the policy considers these investigational, and check codes 28890, 0101T and 0102T against that list, which the code reference marks as investigational.
02Billing team: All codes billed for shock wave therapy for salivary stones are not eligible for coverage, and code 42699 is listed as an unlisted salivary procedure.
03Billing team: For kidney stone shock wave therapy, which the policy considers eligible for coverage, the code reference lists CPT 50590, anesthesia codes 00872 and 00873, HCPCS S0400, and ICD-10 diagnosis codes N20.0, N20.1 and N20.2.
04Billing team: For Federal Employee Program members, FDA-approved devices may not be considered investigational and may be assessed only on medical necessity.

Codes mentioned

2889042699008720087350590S0400N20.0N20.1N20.2

Original notice

Extracorporeal Shock Wave Treatment for Plantar Fasciitis and Other Musculoskeletal Conditions
bcbsms.com · Always check the source before changing claims.
View original ↗

Related policy hubs

Blue Cross & Blue Shield of Mississippi policiesOrthopedicsPodiatrySports MedicineUrologyCode 28890Code 42699Code 00872Code 00873Code 50590Code S0400Code N20.0Code N20.1Code N20.2

Summaries are AI-assisted. Always confirm against the original payer notice.

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