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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that electrical stimulation to augment bone repair can be attained either invasively or non-
invasively. Invasive devices provide electrical stimulation directly at the fracture site either through 
percutaneously placed cathodes or by implantation of a coiled cathode wire into the fracture site. The power 
pack for the latter device is implanted into soft tissue near the fracture site and subcutaneously connected to the 
cathode, creating a self-contained system with no external components. The power supply for the former device 
is externally placed and the leads connected to the inserted cathodes. With the non-invasive device, opposing 
pads, wired to an external power supply, are placed over the cast. An electromagnetic field is created between 
the pads at the fracture site. 
 
An ultrasonic osteogenic stimulator is a noninvasive device that emits low intensity, pulsed ultrasound. The 
device is applied to the surface of the skin at the fracture site and ultrasound waves are emitted via a conductive 
coupling gel to stimulate fracture healing. The ultrasonic osteogenic stimulators are not used concurrently with 
other non-invasive osteogenic devices.  
 
The noninvasive stimulator device is covered only for the following indications: 
 
Nonunion of long bone fractures; 
Failed fusion, where a minimum of 9 months has elapsed since the last surgery; 
Congenital pseudarthroses; 
Effective July 1, 1996, as an adjunct to spinal fusion surgery for patients at high risk of pseudarthrosis due to 
previously failed spinal fusion at the same site or for those undergoing multiple level fusion. A multiple level 
fusion involves 3 or more vertebrae (e.g., L3-L5, L4-S1, etc.). 
Effective September 15, 1980, nonunion of long bone fractures is considered to exist only after 6 or more 
months have elapsed without healing of the fracture. 
Effective April 1, 2000, nonunion of long bone fractures is considered to exist only when serial radiographs 
have confirmed that fracture healing has ceased for 3 or more months prior to starting treatment with the 
electrical osteogenic stimulator. Serial radiographs must include a minimum of 2 sets of radiographs, each 
including multiple views of the fracture site, separated by a minimum of 90 days. 
Invasive (Implantable) Stimulator The invasive stimulator device is covered only for the following indications: 
 
Nonunion of long bone fractures; 
Effective July 1, 1996, as an adjunct to spinal fusion surgery for patients at high risk of pseudarthrosis due to 
previously failed spinal fusion at the same site or for those undergoing multiple level fusion. A multiple level 
fusion involves 3 or more vertebrae (e.g., L3-L5, L4-S1, etc.). 
Effective September 15, 1980, nonunion of long bone fractures is considered to exist only after 6 or more 
months have elapsed without healing of the fracture. 
Effective April 1, 2000, nonunion of long bone fractures is considered to exist only when serial radiographs 
have confirmed that fracture healing has ceased for 3 or more months prior to starting treatment with the 
electrical osteogenic stimulator. Serial radiographs must include a minimum of 2 sets of radiographs, each 
including multiple views of the fracture site, separated by a minimum of 90 days. 
 
You can find these rules in the National Coverage Determination (NCD) Osteogenic Stimulators 150.2. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules.