Extracorporeal Shock Wave Therapy (ESWT)

Jurisdiction: JJ Part B. States: Alabama, Georgia, Tennessee. Type: Active LCD

Extracorporeal shock wave therapy (ESWT) is a non-invasive treatment that involves delivery of an acoustic shock wave to a specific area of the body. The objective of this treatment is to reduce pain and stimulate healing of the affected area. The acoustic waves travel through fluid and soft tissue, and their effects occur at sites where there is a change in impedance, such as the bone/soft-tissue interface. ESWT has become a proposed treatment option for specific musculoskeletal conditions. These conditions include, but are not limited to, calcific tendinopathy of the shoulder, elbow tendinopathy (lateral/medial epicondylitis), carpal tunnel syndrome (CTS), greater trochanteric pain syndrome (GTPS), fractures and delayed unions/nonunions, osteonecrosis of the femoral head (ONFH), and patellar tendinopathy (PT). The mechanism by which ESWT achieves a therapeutic intervention in musculoskeletal conditions is not completely known. Numerous hypotheses have been proposed: ESWT may disrupt fibrous tissue allowing for the subsequent promotion of revascularization and healing of tissue. Direct and indirect effects of the shock waves may damage cell membranes; reducing the ability of nociceptors to transmit pain signals 11 and/or promote healing. Shock waves break up calcium deposits, loosen structures, and promote resorption of calcium; thereby decreasing pain and improving function. This A/B MAC considers ESWT (high energy) not reasonable and necessary for the treatment of musculoskeletal conditions and therefore not covered.