Anthem Blue Cross Connecticut Commercial Clinical Policy

Anthem Blue Cross Connecticut MED.00096 Low-Frequency Ultrasound Therapy for Wound Management Form

Effective Date

09/27/2023

Last Reviewed

08/10/2023

Original Document

  Reference



MED.00096 Low-Frequency Ultrasound Therapy for Wound Management

Subject:

Description

This document addresses the use of low-frequency, non-contact, non-thermal ultrasound therapy for wound management.

Note: Please see the following related document for additional information:

  • CG-DME-48 Vacuum Assisted Wound Therapy in the Outpatient Setting

Position Statement

Investigational and Not Medically Necessary:

Use of low-frequency, non-contact, non-thermal, ultrasound therapy is considered investigational and not medically necessary for all applications.