2c661865_trasonic___HealthPartners_Care___Indications_Contraindications
[HCPCS Code] E0760 [Device Name and Manufacturer] Exogen 4000+ Manufacturer: Smith & Nephew Established nonunions excluding skull and vertebra Fresh, closed, posteriorly displaced distal radius fractures Fresh, closed tibial diaphysis fractures *Note: FDA approved as a single user device
Nonunion fracture of skull or vertebra Fresh fractures other than the distal radius or tibial diaphysis Fresh fractures with post-reduction displacement of more than 50% Fresh fractures due to bone pathology or malignancy Recipients who are not skeletally mature (usually not under age 18) Recipients who are pregnant or nursing Recipients who have active, implantable devices such as cardiac pacemakers, unless documentation from the cardiologist established that use of the bone growth stimulator is safe and appropriate Recipients with thrombophlebitis, vascular insufficiency, abnormal skin sensitivity, sensory paralysis, alcoholism and/or nutritional deficiency Recipients receiving steroid, anti-coagulant, prescription non-steroidal anti-inflammatory, calcium channel blocker and/or diphosphonate therapy
Bone stimulators, electronic and ultrasonic – HealthPartners Care
MHCP Non-Covered Indications/Contraindications