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Low Intensity Pulsed Ultrasound Fracture Healing Device

Blue Cross & Blue Shield of Mississippi·MS · Orthopedics, Family Medicine, Internal Medicine +1 more·Medical Policy
Effective date
Not stated
We identified it
Jun 20, 2026
Days to comply

Summary

This policy establishes medical necessity criteria for Low Intensity Pulsed Ultrasound (LIPUS) fracture healing devices, covering specific fresh fractures in high-risk patients, delayed unions, and nonunions. The devices are covered as durable medical equipment with specific clinical criteria that must be met.

Action Required

Action needed
Immediately: Billing team must establish protocols for LIPUS device authorization requests. Verify patients meet medical necessity criteria including high-risk factors (diabetes, steroid therapy, osteoporosis, smoking, alcoholism) or specific fracture locations (Jones fracture, scaphoid, metatarsal). Document delayed union (3+ months post-fracture with decelerating healing) or nonunion (6+ months with no progression for 3 consecutive months) with serial radiographs. Process as DME benefit with applicable co-insurance. Claims without proper documentation of risk factors or healing status will be denied.