Shockwave therapy is generally not covered by insurance plans. The treatment will be billed with the license of the treating therapist. If you have extended health insurance for physical therapy or chiropractic treatments, your plan should cover it. The description of the CPT 0101T code is “Extracorporeal shock wave therapy involving the musculoskeletal system”., without specifying anything else, of high energy”.
The keywords muscle hypertonia OR spasticity were used for spasticity, and the keywords shock wave O ESWT were used for ESWT. Whether insurance covers shockwave therapy depends largely on your individual insurance provider and the specific details of your policy. This clinical policy bulletin addresses extracorporeal shock wave therapy for musculoskeletal indications and soft tissue injuries. At the clinic, a technician would expose the injured body part and use the portable ESWT device to administer the therapy with shock waves.
While ESWT has shown promise in treating a variety of conditions, coverage of ESWT by insurance providers remains limited and depends largely on the specific condition being treated. There are several devices available on the market with a radial or focal shock wave source, such as electrohydraulic, electromagnetic and piezoelectric generators, and each type of device employs a different treatment protocol. An evaluation of the ESWT for refractory tennis elbow conducted by the National Institute for Clinical Excellence (NICE, 200) concluded that, while the evidence on extracorporeal shock wave therapy for refractory tennis elbow does not pose significant safety concerns, the evidence on its effectiveness is inconsistent. Each of these conditions has had some success with ESWT in clinical practice, but in the absence of more extensive evidence in the medical literature, many insurers maintain their position on against covering the ESWT in these cases.
Shockwave therapy devices emit shock waves of acoustic energy in a nanosecond or microsecond phase to stimulate healing of injured soft tissues, ligaments and tendons. Shockwave therapy offers a non-pharmacological, non-invasive treatment for erectile dysfunction, requiring only a topical anesthetic solution and a series of six sessions with no recovery period. The placebo-controlled study evaluated 166 patients undergoing extracorporeal shockwave treatment to treat plantar fasciitis and concluded that “there was no evidence to support a beneficial effect on pain, function and quality of life” when comparing shock wave treatment with placebo treatment. While the ESWT is promising, many insurers consider it to be in the research phase for a variety of conditions due to a lack of research or to disparate results.
The LisWT has been used in orthopedics for years to help heal bone fractures, injured ligaments and injured tendons. LisWT has also been used to improve wound healing by using specific high-energy sound waves to accelerate tissue repair and cell growth. An UpToDate review of “Achilles Tendinopathy and Tendon Rupture” (Ham and Maughan, 201) states that “more studies are needed to determine the role of shock wave therapy and topical nitrates.” Aetna believes that extracorporeal shock wave therapy (ESWT) is medically necessary for calcified shoulder tendinopathy of at least 6 months with a calcium deposit of 1 cm or more and for those who have not responded to appropriate conservative treatments (e.g.