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EXTRACORPOREAL SHOCK WAVE TREATMENT (ESWT)

EXTRACORPOREAL SHOCK Wave TREATMENT (ESWT) Page 1 of 3 UnitedHealthcare Medicare Advantage Policy Guideline Approved 08/12/2020 Proprietary Information of UnitedHealthcare. Copyright 2020 United HealthCare Services, Inc. EXTRACORPOREAL SHOCK WAVE TREATMENT (ESWT) Guideline Number: Approval Date: August 12, 2020 Table of Contents Page POLICY SUMMARY .. 1 APPLICABLE CODES .. 1 DEFINITIONS .. 2 PURPOSE .. 2 REFERENCES .. 2 GUIDELINE HISTORY/REVISION INFORMATION .. 2 TERMS AND CONDITIONS .. 3 POLICY SUMMARY Overview EXTRACORPOREAL SHOCK wave therapy (ESWT) devices are similar to the lithotripters used for breaking up kidney stones in urology. They produce low- or high-energy pulses arising from acoustic energy, called SHOCK waves , which can be focused and then propagated through water within body tissues.

Extracorporeal Shock Wave Treatment (ESWT) Page 1 of 4 ... Extracorporeal shock wave therapy (ESWT), using either a high- or low-dose protocol or a radial wave, is considered not medically necessary for all indications, including but not limited to the treatment of:

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  Treatment, Shocks, West, Therapy, Waves, Extracorporeal, Extracorporeal shock wave therapy, Extracorporeal shock wave treatment

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