HCPCS E0747: Osteogenesis Stimulator, Electrical, Noninvasive

## **HCPCS code E0747 documentation requirements** Coverage for E0747 is strictly governed by national and local coverage determinations (NCDs/LCDs), such as those set by Medicare. Key documentation components generally required include: - **Detailed Written Order (DWO) / prescription**: A prescription signed and dated by the treating physician/practitioner. A Written Order Prior to Delivery (WOPD) is often required, meaning the supplier must have a complete, signed, and dated order before dispensing the device. - **Face-to-face encounter**: Documentation in the medical record that the beneficiary was evaluated and/or treated for a condition that supports the need for the item. - **Medical necessity criteria**: The medical record must clearly demonstrate that the patient meets the specific coverage criteria for a non-spinal electrical osteogenesis stimulator, which typically includes diagnosis and time since fracture/surgery. - **Radiographic evidence**: Non-union must be documented by a minimum of two sets of radiographs obtained prior to starting treatment, separated by a minimum of 90 days. Each set must include multiple views with a written interpretation by the treating physician or practitioner stating that fracture healing has ceased for three or more months prior to starting treatment. - **Other requirements**: The bone must not be infected, and the fracture gap is typically required to be less than one centimeter (cm). - **Progress notes**: Detailed chart notes and medical records pertinent to the request, including history and physical, documenting the condition and symptoms.

## **E0747 billing requirements** To ensure proper reimbursement for HCPCS code E0747, the following requirements must be met and guidelines must be considered: - **Billing entity**: The code is generally billed by the Durable Medical Equipment (DME) supplier. - **Required modifier:** As devices coded E0747 are often classified by the FDA as Class III devices, claims generally must include the KF modifier ("DMEPOS item subject to FDA Class III regulatory controls"). - **Jurisdiction**: Claims for DMEPOS items like E0747 are typically submitted to a Durable Medical Equipment Medicare Administrative Contractor (DME MAC). - **Non-covered or medically unnecessary services**: If the service is expected to be denied as not medically necessary due to not meeting the NCD/LCD criteria, an Advance Beneficiary Notice of Noncoverage (ABN) must be obtained. The claim should then include the GA modifier ("Waiver of liability statement issued, as required by payer policy, individual case"). To add, if the provider chooses to not submit an ABN, the GZ modifier ("Item or service expected to be denied as not reasonable and necessary") should be used. - **"Reasonable and Necessary" criterion**: The item must meet all the "reasonable and necessary" requirements established in the relevant NCD and LCD. The KX modifier ("Requirements specified in the medical policy have been met") is often used to attest that documentation supporting medical necessity is on file. Do not bill when using the device for stress fractures or pathological fractures, as these conditions are not considered eligible indications for coverage under current payer medical policies.

## **Other relevant codes** - **E0748**: Osteogenesis stimulator, electrical, noninvasive, spinal applications. Use this code for bone growth stimulation following failed spinal fusion, multilevel spinal fusion surgery, or following spinal fusion surgery where there is a history of a previously failed spinal fusion at the same site. - **E0749**: Osteogenesis stimulator, electrical, surgically implanted (used when the stimulator is implanted internally) - **E0760**: Osteogenesis stimulator, low intensity pulsed ultrasound, noninvasive (alternative modality for bone healing) - **20974 (CPT code)**: Electrical stimulation to aid bone healing; noninvasive (nonoperative)