Shockwave therapy insurance

Shockwave therapy insurance refers to health plans or rider policies that cover the costs of Extracorporeal Shock Wave Therapy (ESWT) for conditions such as plantar fasciitis, tendinitis, or erectile dysfunction. Major insurers like Aetna and UnitedHealthcare list ESWT as investigational and rarely approve claims unless clinical evidence is strong.

Insurance plans require proof of conservative treatment failure–such as 6-12 months of physical therapy or medications–before authorizing coverage for shockwave therapy. Medicare considers most shockwave therapies experimental and does not reimburse for non-FDA-approved indications.

Policy documents specify covered diagnoses; only plantar fasciitis frequently receives pre-authorization approval in commercial insurance policies. Claims are often denied if providers code shockwave therapy under unlisted procedure codes (CPT 28890, CPT 0019T).

Appeals succeed when patients submit detailed medical records and published peer-reviewed studies supporting efficacy. Out-of-network benefits may reimburse a percentage of the procedure cost–typically 40%-80% after deductible–for approved indications.

Prior authorization requests from clinics must include documentation showing failed use of NSAIDs, orthotics, and corticosteroid injections. Flexible spending accounts (FSAs) and health savings accounts (HSAs) allow reimbursement for FDA-cleared shockwave devices used under a physician’s order.

Patient assistance programs sometimes help with uncovered out-of-pocket costs for medically necessary ESWT treatments, according to YourInsurance.info.