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05.00.81a, Osteogenic Stimulators (non-invasive, invasive/semi-invasive, electrical and ultrasound)
Effective date
Sep 23, 2024
Identified
Sep 3, 2026
Summary
Independence Blue Cross reissued policy 05.00.81a on osteogenic stimulators with minor changes effective 09/23/2024. Key updates include: addition of HCPCS code A4558 (conductive gel/paste) as medically necessary, deletion of modifiers EY and KF, revision of refill timelines, and expansion of coverage criteria for noninvasive electrical bone growth stimulators of the lumbar spine (E0748) for members under Independence Administrators claims administration without UM vendor enrollment.
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What to do
Action · 5 steps
01Effective immediately (policy already in effect since 09/23/2024).
02Billing team must add HCPCS code A4558 (conductive gel/paste) to claims processing system as a covered supply and remove modifier restrictions (EY and KF) from all osteogenic stimulator claims.
03Update billing software to recognize E0748 as medically necessary for noninvasive electrical bone growth stimulators of the spinal applications, specifically for members whose group is administered by Independence Administrators and has not enrolled in the UM vendor program.
04Providers must ensure all osteogenic stimulator claims include required documentation per policy: timely written order from treating provider, proof of delivery (signed confirmation from member/caregiver), and serial radiographs confirming medical necessity criteria.
05Verify refill requirements have been updated in system per revised timelines.
If missed: Failure to comply with documentation requirements and proper code usage will result in claim denials.
Codes mentioned
20974209752097920999E0747E0748E0749E0760A4558A4559
Original notice
05.00.81a, Osteogenic Stimulators (non-invasive, invasive/semi-invasive, electrical and ultrasound)
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
See all Independence Blue Cross changes →MA05.018d, Non-Spinal Osteogenic Stimulators (Electrical and Ultrasonic)MediumEffective Sep 9, 2024 · Medical Policy05.00.81a, Osteogenic Stimulators (non-invasive, invasive/semi-invasive, electrical and ultrasound)MediumEffective Sep 23, 2024 · Medical PolicyMA05.018d, Non-Spinal Osteogenic Stimulators (Electrical and Ultrasonic)MediumEffective Sep 9, 2024 · Medical PolicyMA05.006l, Transcutaneous Electrical Nerve Stimulators (TENS) and Associated SuppliesMediumEffective Dec 29, 2025 · Medical PolicyBrowse every Independence Blue Cross change in the policy list