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Independence Blue CrossCommercial · Administrative · Medical Policy · Orthopedics, Sports Medicine, Pain Management +1 moreLow impact

11.14.13h, Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions

Effective date
Not stated in the notice
Identified
Jun 19, 2026

Summary

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.

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What to do

Action · 5 steps
01No immediate action required.
02This is a reissue with no changes to coverage status or billing requirements.
03Billing team should confirm that current claim edits continue to deny CPT codes 0101T, 0102T, 28890, and 20999 when billed for musculoskeletal ESWT treatment on Independence Blue Cross commercial plans.
04Verify that denial reason code reflects experimental/investigational status.
05No workflow changes are needed.

Codes mentioned

2889020999

Original notice

11.14.13h, Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions
medpolicy.ibx.com · Always check the source before changing claims.
View original ↗

Related changes

See all Independence Blue Cross changes →
MA11.087c, Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal ConditionsMediumNo effective date · Medical PolicyMA11.087c, Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal ConditionsLowNo effective date · Medical Policy11.14.13h, Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal ConditionsLowNo effective date · Medical PolicyMA05.018d, Non-Spinal Osteogenic Stimulators (Electrical and Ultrasonic)MediumEffective Sep 9, 2024 · Medical PolicyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesOrthopedicsSports MedicinePain ManagementPodiatryCode 28890Code 20999

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