HCPCS code E0760: Osteogenesis stimulator, low intensity

Obtain a list of documentation and billing requirements for HCPCS code E0760 from our short guide.

## **What is HCPCS code E0760?** HCPCS code E0760 represents an osteogenesis stimulator, a low-intensity ultrasound, non-invasive device classified as durable medical equipment (DME). It is designed to promote bone healing by delivering pulsed, low-intensity ultrasound waves through the skin at the fracture site to stimulate bone growth. The EXOGEN® Ultrasound Bone Healing System is the most widely recognized product billed under this code. Medicare coverage for E0760 is guided by the applicable Local Coverage Determination (LCD) and is generally limited to established nonunion fractures, not fresh fractures or delayed unions. To document a nonunion, two sets of radiographs must be obtained at least 90 days apart, with multiple views of the fracture site. A treating practitioner must provide a written interpretation confirming that there has been no clinically significant evidence of healing between the two radiograph sets. The fracture site must not involve the skull or vertebrae and must not be related to tumors or pathological fractures caused by malignancy. The device must be prescribed for home use or another covered place of service for DME benefits to apply, and all supporting documentation—including radiology reports, physician’s order, and proof of delivery—must be maintained and available for audit. Some private insurers and state Medicaid programs may impose additional requirements, such as evidence of failed surgical or medical interventions before approving coverage. Regardless of payer, E0760 is not covered for fresh fractures, delayed unions, or fractures where healing is still progressing.

## **HCPCS code E0760 documentation requirements** To be eligible for coverage, the documentation must show the device is medically necessary. Specific requirements to support this often include: - A written order prior to delivery (WOPD) from the treating practitioner. This is a crucial step that must be completed before the patient obtains the DMEPOS item. - A face-to-face encounter with the patient is required for the treating practitioner to document the need for the device. - Radiographic evidence of a non-union fracture. This is typically documented with at least two sets of X-rays taken at least 90 days apart, showing no significant signs of healing. The fracture must not be of the skull or vertebrae. - A written interpretation from a physician confirming the lack of healing and medical necessity for the stimulator. - The fracture site must not be infected. - The gap between the bone fragments should generally be less than 1 cm.

## **E0760 billing requirements** Billing for HCPCS code E0760 has specific, reasonable guidelines to ensure proper reimbursement: - **Modifiers**: Claims for E0760 must include the KF modifier as it is a Class III medical device. Other modifiers, such as NU (new equipment purchase), UE (used equipment), or RR (rental), are also required. - **Code verification**: Some payers may require a coding verification review by the Pricing, Data Analysis and Coding (PDAC) contractor. Check with the specific payer for their requirements. - **Payment**: Payments for these stimulators are sometimes split into two parts: an initial payment upon dispensing the device and a second payment after a re-evaluation of the patient's treatment plan, typically after 90 days. - **Bundled services**: The cost of the device (E0760) is generally separate from the professional services of the physician (e.g., CPT codes like 20979). It's essential to check with the payer to see if they will authorize both the device and the professional service codes.

## **Other relevant codes** - **E0747**: Osteogenesis stimulator, electrical, non-invasive, other than spinal applications - **E0748**: Osteogenesis stimulator, electrical, non-invasive, spinal applications - **E0749**: Osteogenesis stimulator, electrical, surgically implanted

Frequently asked questions

It is considered medically necessary for nonunion fractures (excluding skull/vertebrae, non-tumor-related) documented by two radiograph sets ≥ 90 days apart, showing no healing.

Yes. A treating practitioner must have a face-to-face encounter with the patient within six months before prescribing E0760, and this must be documented.

The ultrasound waves can penetrate soft tissue but cannot penetrate metal. If the patient has a cast, a port or window must be created to allow for direct contact with the skin. The device should not be applied directly over metal hardware.