WAC 182-543-3300. Covered — Osteogenesis electrical stimulator (bone growth stimulator) — Noninvasive

(1) The medicaid agency covers, with prior authorization, noninvasive osteogenesis electrical stimulators, also known as bone growth stimulators, limited to one per client, in a five-year period. (2) The agency pays for the purchase of nonspinal bone growth stimulators, only when: (a) The stimulators have pulsed electromagnetic field (PEMF) stimulation; and (b) The client meets one or more of the following clinical criteria: (i) Has a nonunion of a long bone fracture (which includes clavicle, humerus, phalanx, radius, ulna, femur, tibia, fibula, metacarpal and metatarsal) where three months have elapsed since the date of injury without healing; or (ii) Has a failed fusion of a joint, other than in the spine, where a minimum of nine months has elapsed since the last surgery; or (iii) Diagnosed with congenital pseudarthrosis. (3) The agency pays for the purchase of spinal bone growth stimulators, when: (a) Prescribed by a neurologist, an orthopedic surgeon, or a neurosurgeon; and (b) The client meets one or more of the following clinical criteria: (i) Has a failed spinal fusion where a minimum of nine months has elapsed since the last surgery; or (ii) Is post-op from a multilevel spinal fusion surgery; or (iii) Is post-op from spinal fusion surgery and there is a history of a previously failed spinal fusion. (4) The agency pays for the purchase of ultrasonic noninvasive bone growth stimulators when: (a) Prescribed by a neurologist, an orthopedic surgeon, or a neurosurgeon; and (b) The client meets all the following clinical criteria: (i) Nonunion confirmed by two radiographs minimum 90 days apart; and (ii) Physician statement of no clinical evidence of fracture healing.