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December 2016 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 9 Physician : 9.2 Services, Benefits, Limitations, and Prior Authorization : 9.2.14 Bone Growth Stimulation : 9.2.14.2 Non-invasive Bone Growth Stimulation

9.2.14.2
Non-invasive bone growth stimulation (procedure code 20974) is indicated for the following conditions:
Nonunions, failed fusions, and congenital pseudarthrosis where there is no evidence of progression of healing for three or more months despite appropriate fracture care.
Documentation must also indicate all of the following:
Non-invasive bone growth stimulation for spinal application is indicated for the following conditions:
Other risk factors for fusion failure are present, including gross obesity, degenerative osteoarthritis, severe spondylolisthesis, current smoking, previous fusion surgery, previous disc surgery, or gross instability.

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