This document addresses the use of extracorporeal shock wave therapy (ESWT), including Extracorporeal Pulse Activation Therapy (EPAT^®), for the treatment of musculoskeletal conditions, soft tissue injuries, and erectile dysfunction.

Note: This document does not address extracorporeal shock wave lithotripsy.

Position Statement

Investigational and Not Medically Necessary:

Use of Extracorporeal Shock Wave Therapy (ESWT), including but not limited to the use of Extracorporeal Pulse Activation Therapy (EPAT^®), for the treatment of musculoskeletal conditions and soft tissue injuries is considered investigational and not medically necessary. These conditions include, but are not limited to:

• Chronic plantar fasciitis
• Calcified tendinitis of shoulder
• Chronic lateral epicondylitis (tennis elbow)
• Elbow tendinitis
• Erectile dysfunction
• Fixation of loosened cemented orthopedic prosthesis
• Non-union fractures
• Peyronie’s disease
• Soft tissue or wound repair