What It Is
An electrical or ultrasound device, to be used by the patient at home, to stimulate bone growth (osteogenesis) during the healing of a bone fracture or fusion
What's Covered
Medicare Part B pays for the rental of a bone growth stimulator if prescribed by a doctor. In addition, before the patient rents or purchases the equipment, the prescribing doctor must send Medicare a written request for approval, called a Certificate of Medical Necessity. The equipment must be rented or purchased from a Medicare-certified medical equipment supplier.
If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different copayments for a bone growth stimulator, contact the plan directly.
What Medicare Pays
Medicare Part B pays 80 percent of the Medicare-approved amount for rental of a bone growth stimulator; the patient is responsible for the remaining 20 percent.
Warning: If a device is rented from what's called a Medicare "participating supplier," the supplier can't charge more than the Medicare-approved amount. However, a supplier who's enrolled in Medicare but isn't an officially participating supplier may charge more than the Medicare-approved amount. In that case, the patient must personally pay the difference between the Medicare-approved amount and the amount the supplier actually charges (on top of the 20 percent of the Medicare-approved amount that Medicare doesn't pay).
Important: Regardless of the rules regarding any particular type of care or equipment, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care or equipment must meet two basic requirements:
The care or equipment must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care or equipment is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?
The care or equipment must be provided by a healthcare provider or equipment supplier who participates in Medicare.
