Key facts for NCD 150.2
- Benefit category
- Durable Medical Equipment
- Effective date
- 04/27/2005
- Implemented 08/01/2005
- Transmittal
- Transmittal 41
- Versions published
- 2
- Manual chapter
- 150
- NCD Manual (Pub. 100-03)
TL;DR
NCD 150.2 sets Medicare's national policy for osteogenic stimulators under the benefit category "Durable Medical Equipment", effective 04/27/2005 and implemented 08/01/2005. The noninvasive stimulator device is covered only for the following indications: It has been revised 1 time since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
Electrical Osteogenic Stimulators
A. General
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.
Ultrasonic Osteogenic Stimulators
A. General
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 be used concurrently with other non-invasive osteogenic devices.
Indications and limitations of coverage
Electrical Osteogenic Stimulators
B. Nationally Covered Indications
• Noninvasive Stimulator
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.
Ultrasonic Osteogenic Stimulators
B. Nationally Covered Indications
Effective January 1, 2001, ultrasonic osteogenic stimulators are covered as medically reasonable and necessary for the treatment of nonunion fractures. In demonstrating non-union fractures, CMS expects:
• A minimum of 2 sets of radiographs, obtained prior to starting treatment with the osteogenic stimulator, separated by a minimum of 90 days. Each radiograph set must include multiple views of the fracture site accompanied with a written interpretation by a physician stating that there has been no clinically significant evidence of fracture healing between the 2 sets of radiographs; and,
• Indications that the patient failed at least one surgical intervention for the treatment of the fracture.
• Effective April 27, 2005, upon reconsideration of ultrasound stimulation for nonunion fracture healing, CMS determines that the evidence is adequate to conclude that noninvasive ultrasound stimulation for the treatment of nonunion bone fractures prior to surgical intervention is reasonable and necessary. In demonstrating non-union fractures, CMS expects:
• A minimum of 2 sets of radiographs, obtained prior to starting treatment with the osteogenic stimulator, separated by a minimum of 90 days. Each radiograph set must include multiple views of the fracture site accompanied with a written interpretation by a physician stating that there has been no clinically significant evidence of fracture healing between the 2 sets of radiographs.
C. Nationally Non-Covered Indications
Nonunion fractures of the skull, vertebrae and those that are tumor-related are excluded from coverage.
Ultrasonic osteogenic stimulators may not be used concurrently with other non-invasive osteogenic devices.
Ultrasonic osteogenic stimulators for fresh fractures and delayed unions remains non-covered.
(This NCD last reviewed June 2005.)
Text reproduced from the CMS Medicare Coverage Database record for NCD 150.2 version 2. View the original on cms.gov.
Revision history
06/2005 - Determined evidence adequate to conclude that non-invasive ultrasound stimulation for treatment of nonunion bone fractures prior to surgical intervention is reasonable and necessary. Effective date 04/27/2005. Implementation date 08/01/2005. ( TN 41 ) (CR 3836)
11/2000 - Permited coverage for ultrasonic osteogenic stimulators when two sets of radiographs document nonunion of fracture, and patient has failed at least one surgical intervention for treatment of fracture. Effective and implementation dates 01/01/2001. ( TN 131 )
02/2000 - Defined nonunion of long bone fractures when fracture healing has ceased for 3 or more months as confirmed by serial radiographs. Effective and implementation dates 04/01/2000. ( TN 123 ) (CR 1085)
03/1997 - Denied coverage for osteogenic stimulators due to insufficient evidence to support medical necessity. Effective date 04/03/1997. (TN 92)
06/1996 - Expanded coverage to include use as an adjunct to spinal fusion surgery and provided clarification when noninvasive osteogenic stimulation is indicated after failed fusion. Effective date 07/01/1996. (TN 85)
How this NCD shows up on remittances
A service denied under a National Coverage Determination returns CARC 50 (not deemed medically necessary) with remark N386 (decision based on an NCD); a denial citing a local policy instead carries N115. Because NCDs bind nationally, the appeal path is documentation that the patient meets the indications above, not a contractor-policy argument.
How QuickIntell applies NCD 150.2
QuickAuth checks the ordered service and diagnosis against NCD and LCD criteria before the encounter, QuickCode validates the diagnosis pairing on the claim, and QuickRCM routes CARC 50 denials with the policy text and the covered-code list attached so the appeal starts with evidence.
Frequently asked questions — NCD 150.2
What does NCD 150.2 cover?
The noninvasive stimulator device is covered only for the following indications: The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 150.2 take effect?
The current version (2) is effective 04/27/2005, implemented 08/01/2005, published in transmittal 41. CMS lists 2 versions of this NCD.
Does a Local Coverage Determination override NCD 150.2?
No. A National Coverage Determination binds all Medicare Administrative Contractors; an LCD can only address services or circumstances the NCD leaves open. Claims denied under this NCD typically return CARC 50 with remark N386 (NCD) rather than N115 (LCD).
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database NCDs via the CMS Coverage APIVersion API snapshot 2026-09-27 · effective 2026-09-20 · file national-coverage-ncd.jsonSHA-256 a90fadfd264b9ef4…
Disclaimer
This page reproduces the CMS National Coverage Determination text and, for laboratory NCDs, the CMS ICD-10 edit lists, as an operational reference. Coverage decisions depend on the full policy, the claim and the contractor; nothing here is legal, clinical or billing advice. CPT codes are shown as numbers only; CPT descriptors are copyright AMA.