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Extracorporeal Shock Wave Treatment for Plantar Fasciitis and Other Musculoskeletal Conditions Form

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Extracorporeal Shock Wave Treatment for Plantar Fasciitis and Other Musculoskeletal Conditions

Indications

(1) Does the request meet this criterion: Lateral epicondylitis (“tennis elbow”)? 
(2) Does the request meet this criterion: Shoulder tendinopathy? 
(3) Does the request meet this criterion: Achilles tendinopathy? 
(4) Does the request meet this criterion: Patellar tendinopathy (“jumper's knee”) Fracture Nonunion and Delayed Union The following criteria are used to define fracture nonunion:? 
(5) Does the request meet this criterion: At least 3 months have passed since the date of fracture;? 

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500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 1 (401) 274-4848 WWW.BCBSRI.COM EFFECTIVE DATE: 10|01|2015 POLICY LAST REVIEWED: 08|20|2025 OVERVIEW Extracorporeal shock wave therapy (ESWT) is a noninvasive method used to treat pain with shock or sound waves directed from outside the body onto the area to be treated (e.g., the heel in the case of plantar fasciitis). Shock waves are generated at high- or low-energy intensity, and treatment protocols can include more than one treatment. ESWT has been investigated for use in a variety of musculoskeletal conditions. MEDICAL CRITERIA Not applicable PRIOR AUTHORIZATION Not applicable POLICY STATEMENT Medicare Advantage Plans Extracorporeal shock wave therapy, using either a high- or low-dose protocol or radial ESWT, is not covered as a treatment of musculoskeletal conditions, including but not limited to plantar fasciitis; tendinopathies including tendinitis of the shoulder, Achilles tendinitis, tendinitis of the elbow (lateral epicondylitis), and patellar tendinitis; stress fractures; avascular necrosis of the femoral head; delayed union and nonunion of fractures; and spasticity, as the evidence is insufficient to determine that the technology results in an improvement in the net health outcome. Commercial Products Extracorporeal shock wave therapy, using either a high- or low-dose protocol or radial ESWT, is considered not medically necessary as a treatment of musculoskeletal conditions, including but not limited to plantar fasciitis; tendinopathies including tendinitis of the shoulder, Achilles tendinitis, tendinitis of the elbow (lateral epicondylitis), and patellar tendinitis; stress fractures; avascular necrosis of the femoral head; delayed union and nonunion of fractures; and spasticity, as the evidence is insufficient to determine that the technology results in an improvement in the net health outcome. COVERAGE Benefits may vary between groups and contracts. Please refer to the appropriate Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for applicable not medically necessary/not covered benefits/coverage.
BACKGROUND Chronic Musculoskeletal Conditions Chronic musculoskeletal conditions (eg, tendinitis) can be associated with a substantial degree of scarring and calcium deposition. Calcium deposits may restrict motion and encroach on other structures, such as nerves and blood vessels, causing pain and decreased function. One hypothesis is that disruption of calcific deposits by shock waves may loosen adjacent structures and promote resorption of calcium, thereby decreasing pain and improving function. Plantar Fasciitis Plantar fasciitis is a very common ailment characterized by deep pain in the plantar aspect of the heel, particularly on arising from bed. While the pain may subside with activity, in some patients, the pain persists, interrupting activities of daily living. On physical examination, firm pressure will elicit a tender spot over the medial tubercle of the calcaneus. The exact etiology of plantar fasciitis is unclear, although repetitive injury is Medical Coverage Policy | Extracorporeal Shock Wave Treatment for Plantar Fasciitis and Other Musculoskeletal Conditions

500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 2 (401) 274-4848 WWW.BCBSRI.COM

suspected. Heel spurs are a common associated finding, although it is unproven that heel spurs cause the pain. Asymptomatic heel spurs can be found in up to 10% of the population.

Tendinitis and Tendinopathies Common tendinitis and tendinopathy syndromes are: • Lateral epicondylitis (“tennis elbow”) • Shoulder tendinopathy • Achilles tendinopathy
• Patellar tendinopathy (“jumper's knee”)

Fracture Nonunion and Delayed Union The following criteria are used to define fracture nonunion:
• At least 3 months have passed since the date of fracture; • Serial radiographs have confirmed that no progressive signs of healing have occurred; • The fracture gap is 1 cm or less; and • The patient can be adequately immobilized and is of an age likely to comply with non-weight bearing limitation.

Delayed union can be defined as a decelerating healing process, as determined by serial radiographs, together with a lack of clinical and radiologic evidence of union, bony continuity, or bone reaction at the fracture site for no less than 3 months from the index injury or the most recent intervention. (In contrast, nonunion serial radiographs show no evidence of healing.)

Other Musculoskeletal and Neurologic Conditions Other musculoskeletal conditions include medial tibial stress syndrome, osteonecrosis (avascular necrosis) of the femoral head, coccydynia, and painful stump neuromas. Neurologic conditions include spasticity, which refers to a motor disorder characterized by increased velocity-dependent stretch reflexes. It is one characteristic of upper motor neuron dysfunction, which may be due to a variety of pathologies.

Treatment Most cases of plantar fasciitis are treated with conservative therapy, including rest or minimization of running and jumping, heel cups, and nonsteroidal-anti-inflammatory drugs. Local steroid injection may also be used. Improvement may take up to 1 year in some cases. For tendinitis and tendinopathy syndromes, conservative treatment often involves rest, activity modifications, physical therapy, and anti-inflammatory medications.

Extracorporeal Shock Wave Therapy Also known as orthotripsy, extracorporeal shock wave therapy (ESWT) has been available since the early 1980s for the treatment of renal stones and has been widely investigated for the treatment of biliary stones. ESWT uses externally-applied shock waves to create a transient pressure disturbance, which disrupts solid structures, breaking them into smaller fragments, thus allowing spontaneous passage and/or removal of stones. The mechanism by which ESWT might have an effect on musculoskeletal conditions is not well- defined.

Other mechanisms are also thought to be involved in ESWT. Physical stimuli are known to activate endogenous pain control systems, and activation by shock waves may “reset” the endogenous pain receptors. Damage to endothelial tissue from ESWT may result in increased vessel wall permeability, causing increased diffusion of cytokines, which may, in turn, promote healing. Microtrauma induced by ESWT may promote angiogenesis and thus aid in healing. Finally, shock waves have been shown to stimulate osteogenesis and promote callous formation in animals, which is the rationale for trials of ESWT in delayed union or nonunion of bone fractures.

There are 2 types of ESWT: focused and radial. Focused ESWT sends medium- to high-energy shockwaves of single pressure pulses lasting microseconds, directed on a specific target using ultrasound or radiographic

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guidance. Radial ESWT (RSW) transmits low- to medium-energy shockwaves radially over a larger surface area. The U.S. (United States) Food and Drug Administration (FDA) approval was first granted in 2002 for focused ESWT devices and in 2007 for RSW devices.

Currently, 6 focused ESWT devices have been approved by FDA through the premarket approval process for orthopedic use: • OssaTron® device (HealthTronics) - Approval date: 2000. Delivery system: Electrohydraulic. Indications: chronic proximal plantar fasciitis, i.e., pain persisting >6 months and unresponsive to conservative management; lateral epicondylitis • Epos™ Ultra (Dornier) - Approval date: 2002. Delivery system: Electromagnetic. Indications: plantar fasciitis. • Sonocur® Basic (Siemens) - Approval date: 2002. Delivery system: Electromagnetic. Indications: chronic lateral epicondylitis (unresponsive to conservative therapy for >6 months) • Orthospec™ Orthopedic ESWT (Medispec) - Approval date: 2005. Delivery system: Electrohydraulic spark-gap. Indications: Chronic proximal plantar fasciitis in patients ≥18 years of age. • Orbasone™ Pain Relief System (Orthometrix) - Approval date: 2005. Delivery system: High- energy sonic wave. Indications: Chronic proximal plantar fasciitis in patients ≥18 years of age. • Duolith® SD1 Shock Wave Therapy Device (Storz Medical AG) - Approval date: 2016. Delivery system: Electromagnetic. Indications: Chronic proximal plantar fasciitis in patients ≥18 years of age with history of failed alternative conservative therapies >6 mo

Both high-dose and low-dose protocols have been investigated. A high-dose protocol consists of a single treatment of high-energy shock waves (1300mJ/mm-2). This painful procedure requires anesthesia. A low- dose protocol consists of multiple treatments, spaced one week to one month apart, in which a lower dose of shock waves is applied. This protocol does not require anesthesia. The FDA-labeled indication for the OssaTron and Epos Ultra devices specifically describes a high-dose protocol, while the labeled indication for the Sonocur device describes a low-dose protocol.

In 2007, Dolorclast® (EMS Electro Medical Systems), a radial ESWT, was approved by FDA through the premarket approval process. Radial ESWT is generated ballistically by accelerating a bullet to hit an applicator, which transforms the kinetic energy into radially expanding shock waves. Radial ESWT is described as an alternative to focused ESWT and is said to address larger treatment areas, thus providing potential advantages in superficial applications like tendinopathies. The FDA-approved indication is for the treatment of patients 18 years and older with chronic proximal plantar fasciitis and a history of unsuccessful conservative therapy.

The evidence is insufficient to determine that the technology results in an improvement in the net health outcome for individuals who have the following: • plantar fasciitis • lateral epicondylitis • shoulder tendinopathy • Achilles tendinopathy • patellar tendinopathy • medial tibial stress syndrome • osteonecrosis of the femoral head • nonunion or delayed union • spasticity

500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 4 (401) 274-4848 WWW.BCBSRI.COM

CODING Medicare Advantage Plans and Commercial Products The following CPT codes are not covered for Medicare Advantage Plans and not medically necessary for Commercial Products: 28890 Extracorporeal shock wave, high energy, performed by a physician or other qualified health care professional, requiring anesthesia other than local, including ultrasound guidance, involving the plantar fascia.
0101T Extracorporeal shock wave involving musculoskeletal system, not otherwise specified
0102T Extracorporeal shock wave performed by a physician, requiring anesthesia other than local, and involving the lateral humeral epicondyle

There is no specific CPT code for low-energy or radial ESWT. The unlisted CPT code for general musculoskeletal procedure (20999) should be used.

RELATED POLICIES Medicare Advantage Plans National and Local Coverage Determinations Unlisted Procedures

PUBLISHED Provider Update, October 2025 Provider Update, September 2024 Provider Update, August 2023 Provider Update, October 2022 Provider Update, January 2022

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500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 6 (401) 274-4848 WWW.BCBSRI.COM

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500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 7 (401) 274-4848 WWW.BCBSRI.COM

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500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 8 (401) 274-4848 WWW.BCBSRI.COM

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  3. Kvalvaag E, Roe C, Engebretsen KB, et al. One year results of a randomized controlled trial on radial Extracorporeal Shock Wave Treatment, with predictors of pain, disability and return to work in patients with subacromial pain syndrome. Eur J Phys Rehabil Med. Jun 2018; 54(3): 341-350. PMID 28655271
  4. Kvalvaag E, Brox JI, Engebretsen KB, et al. Effectiveness of Radial Extracorporeal Shock Wave Therapy (rESWT) When Combined With Supervised Exercises in Patients With Subacromial Shoulder Pain: A Double-Masked, Randomized, Sham-Controlled Trial. Am J Sports Med. Sep 2017; 45(11): 2547-2554. PMID 28586628
  5. Kim EK, Kwak KI. Effect of extracorporeal shock wave therapy on the shoulder joint functional status of patients with calcific tendinitis. J Phys Ther Sci. Sep 2016; 28(9): 2522-2524. PMID 27799684
  6. Kim YS, Lee HJ, Kim YV, et al. Which method is more effective in treatment of calcific tendinitis in the shoulder? Prospective randomized comparison between ultrasound-guided needling and extracorporeal shock wave therapy. J Shoulder Elbow Surg. Nov 2014; 23(11): 1640-6. PMID 25219475
  7. Schofer MD, Hinrichs F, Peterlein CD, et al. High- versus low-energy extracorporeal shock wave therapy of rotator cuff tendinopathy: a prospective, randomised, controlled study. Acta Orthop Belg. Aug 2009; 75(4): 452-8. PMID 19774810
  8. Liu S, Zhai L, Shi Z, et al. Radial extracorporeal pressure pulse therapy for the primary long bicipital tenosynovitis a prospective randomized controlled study. Ultrasound Med Biol. May 2012; 38(5): 727-35. PMID 22425375
  9. Mani-Babu S, Morrissey D, Waugh C, et al. The effectiveness of extracorporeal shock wave therapy in lower limb tendinopathy: a systematic review. Am J Sports Med. Mar 2015; 43(3): 752-61. PMID 24817008
  10. Al-Abbad H, Simon JV. The effectiveness of extracorporeal shock wave therapy on chronic achilles tendinopathy: a systematic review. Foot Ankle Int. Jan 2013; 34(1): 33-41. PMID 23386759
  11. Costa ML, Shepstone L, Donell ST, et al. Shock wave therapy for chronic Achilles tendon pain: a randomized placebo-controlled trial. Clin Orthop Relat Res. Nov 2005; 440: 199-204. PMID 16239807
  12. Rasmussen S, Christensen M, Mathiesen I, et al. Shockwave therapy for chronic Achilles tendinopathy: a double-blind, randomized clinical trial of efficacy. Acta Orthop. Apr 2008; 79(2): 249-56. PMID 18484252
  13. Alsulaimani B, Perraton L, Vallance P, et al. Does shockwave therapy lead to better pain and function than sham over 12 weeks in people with insertional Achilles tendinopathy? A randomised controlled trial. Clin Rehabil. Feb 2025; 39(2): 174-186. PMID 39704142
  14. Stania M, Juras G, Marszałek W, et al. Analysis of pain intensity and postural control for assessing the efficacy of shock wave therapy and sonotherapy in Achilles tendinopathy - A randomized controlled trial. Clin Biomech (Bristol, Avon). Jan 2023; 101: 105830. PMID 36469960
  15. Abdelkader NA, Helmy MNK, Fayaz NA, et al. Short- and Intermediate-Term Results of Extracorporeal Shockwave Therapy for Noninsertional Achilles Tendinopathy. Foot Ankle Int. Jun 2021; 42(6): 788-797. PMID 33451253
  16. Pinitkwamdee S, Laohajaroensombat S, Orapin J, et al. Effectiveness of Extracorporeal Shockwave Therapy in the Treatment of Chronic Insertional Achilles Tendinopathy. Foot Ankle Int. Apr 2020; 41(4): 403-410. PMID 31924120
  17. Lynen N, De Vroey T, Spiegel I, et al. Comparison of Peritendinous Hyaluronan Injections Versus Extracorporeal Shock Wave Therapy in the Treatment of Painful Achilles' Tendinopathy: A Randomized Clinical Efficacy and Safety Study. Arch Phys Med Rehabil. Jan 2017; 98(1): 64-71. PMID 27639439
  18. Stania M, Król T, Marszałek W, et al. Treatment of Jumper's Knee with Extracorporeal Shockwave Therapy: A Systematic Review and Meta-Analysis. J Hum Kinet. Oct 2022; 84: 124-134. PMID 36457482
  19. Liao CD, Xie GM, Tsauo JY, et al. Efficacy of extracorporeal shock wave therapy for knee tendinopathies and other soft tissue disorders: a meta-analysis of randomized controlled trials. BMC Musculoskelet Disord. Aug 02 2018; 19(1): 278. PMID 30068324

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  1. van Leeuwen MT, Zwerver J, van den Akker-Scheek I. Extracorporeal shockwave therapy for patellar tendinopathy: a review of the literature. Br J Sports Med. Mar 2009; 43(3): 163-8. PMID 18718975
  2. Thijs KM, Zwerver J, Backx FJ, et al. Effectiveness of Shockwave Treatment Combined With Eccentric Training for Patellar Tendinopathy: A Double-Blinded Randomized Study. Clin J Sport Med. Mar 2017; 27(2): 89-96. PMID 27347857
  3. Smith J, Sellon JL. Comparing PRP injections with ESWT for athletes with chronic patellar tendinopathy. Clin J Sport Med. Jan 2014; 24(1): 88-9. PMID 24366015
  4. Newman P, Waddington G, Adams R. Shockwave treatment for medial tibial stress syndrome: A randomized double blind sham-controlled pilot trial. J Sci Med Sport. Mar 2017; 20(3): 220-224. PMID 27640922
  5. Rompe JD, Cacchio A, Furia JP, et al. Low-energy extracorporeal shock wave therapy as a treatment for medial tibial stress syndrome. Am J Sports Med. Jan 2010; 38(1): 125-32. PMID 19776340
  6. Barnes M. Letter to the editor. "Low-energy extracorporeal shock wave therapy as a treatment for medial tibial stress syndrome". Am J Sports Med. Nov 2010; 38(11): NP1; author reply NP1-2. PMID 20971968
  7. Tan H, Tang P, Chai H, et al. Extracorporeal shock wave therapy with imaging examination for early osteonecrosis of the femoral head: a systematic review. Int J Surg. Jan 01 2025; 111(1): 1144-1153. PMID 38896858
  8. Hao Y, Guo H, Xu Z, et al. Meta-analysis of the potential role of extracorporeal shockwave therapy in osteonecrosis of the femoral head. J Orthop Surg Res. Jul 03 2018; 13(1): 166. PMID 29970103
  9. Zhang Q, Liu L, Sun W, et al. Extracorporeal shockwave therapy in osteonecrosis of femoral head: A systematic review of now available clinical evidences. Medicine (Baltimore). Jan 2017; 96(4): e5897. PMID 28121934
  10. Alves EM, Angrisani AT, Santiago MB. The use of extracorporeal shock waves in the treatment of osteonecrosis of the femoral head: a systematic review. Clin Rheumatol. Nov 2009; 28(11): 1247-51. PMID 19609482
  11. Sansone V, Ravier D, Pascale V, et al. Extracorporeal Shockwave Therapy in the Treatment of Nonunion in Long Bones: A Systematic Review and Meta-Analysis. J Clin Med. Apr 01 2022; 11(7). PMID 35407583
  12. Zelle BA, Gollwitzer H, Zlowodzki M, et al. Extracorporeal shock wave therapy: current evidence. J Orthop Trauma. Mar 2010; 24 Suppl 1: S66-70. PMID 20182240
  13. Wang CJ, Liu HC, Fu TH. The effects of extracorporeal shockwave on acute high-energy long bone fractures of the lower extremity. Arch Orthop Trauma Surg. Feb 2007; 127(2): 137-42. PMID 17053946
  14. Cacchio A, Giordano L, Colafarina O, et al. Extracorporeal shock-wave therapy compared with surgery for hypertrophic long-bone nonunions. J Bone Joint Surg Am. Nov 2009; 91(11): 2589-97. PMID 19884432
  15. Zhai L, Ma XL, Jiang C, et al. Human autologous mesenchymal stem cells with extracorporeal shock wave therapy for nonunion of long bones. Indian J Orthop. Sep 2016; 50(5): 543-550. PMID 27746499
  16. Liu WF, Zhang SM. Extracorporeal Shock Wave Therapy for Limb Dysfunction after Stroke: A Systematic Review and Meta-analysis. Am J Phys Med Rehabil. Jan 03 2025. PMID 39750027
  17. Afzal B, Noor R, Mumtaz N, et al. Effects of extracorporeal shock wave therapy on spasticity, walking and quality of life in poststroke lower limb spasticity: a systematic review and meta-analysis. Int J Neurosci. Dec 2024; 134(12): 1503-1517. PMID 37824712
  18. Otero-Luis I, Cavero-Redondo I, Álvarez-Bueno C, et al. Effectiveness of Extracorporeal Shock Wave Therapy in Treatment of Spasticity of Different Aetiologies: A Systematic Review and Meta-Analysis. J Clin Med. Feb 26 2024; 13(5). PMID 38592705
  19. Mihai EE, Dumitru L, Mihai IV, et al. Long-Term Efficacy of Extracorporeal Shock Wave Therapy on Lower Limb Post-Stroke Spasticity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med. Dec 29 2020; 10(1). PMID 33383655
  20. Cabanas-Valdés R, Serra-Llobet P, Rodriguez-Rubio PR, et al. The effectiveness of extracorporeal shock wave therapy for improving upper limb spasticity and functionality in stroke patients: a systematic review and meta-analysis. Clin Rehabil. Sep 2020; 34(9): 1141-1156. PMID 32513019
  21. Jia G, Ma J, Wang S, et al. Long-term Effects of Extracorporeal Shock Wave Therapy on Poststroke Spasticity: A Meta-analysis of Randomized Controlled Trials. J Stroke Cerebrovasc Dis. Mar 2020; 29(3):
  22. PMID 31899073

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  1. Kim HJ, Park JW, Nam K. Effect of extracorporeal shockwave therapy on muscle spasticity in patients with cerebral palsy: meta-analysis and systematic review. Eur J Phys Rehabil Med. Dec 2019; 55(6): 761-
  2. PMID 31615195
  3. Lee JY, Kim SN, Lee IS, et al. Effects of Extracorporeal Shock Wave Therapy on Spasticity in Patients after Brain Injury: A Meta-analysis. J Phys Ther Sci. Oct 2014; 26(10): 1641-7. PMID 25364134
  4. Fan T, Chen R, Wei M, et al. Effects of radial extracorporeal shock wave therapy on flexor spasticity of the upper limb in post-stroke patients: A randomized controlled trial. Clin Rehabil. Sep 2024; 38(9): 1200-
  5. PMID 38863234
  6. Nada DW, El Sharkawy AM, Elbarky EM, et al. Radial extracorporeal shock wave therapy as an additional treatment modality for spastic equinus deformity in chronic hemiplegic patients. A randomized controlled study. Disabil Rehabil. Sep 2024; 46(19): 4486-4494. PMID 37926696
  7. Brunelli S, Gentileschi N, Spanò B, et al. Effect of Early Radial Shock Wave Treatment on Spasticity in Subacute Stroke Patients: A Pilot Study. Biomed Res Int. 2022; 2022: 8064548. PMID 35909493
  8. Vidal X, Martí-Fàbregas J, Canet O, et al. Efficacy of radial extracorporeal shock wave therapy compared with botulinum toxin type A injection in treatment of lower extremity spasticity in subjects with cerebral palsy: A randomized, controlled, cross-over study. J Rehabil Med. Jun 30 2020; 52(6): jrm00076. PMID 32556354
  9. Li G, Yuan W, Liu G, et al. Effects of radial extracorporeal shockwave therapy on spasticity of upper- limb agonist/antagonist muscles in patients affected by stroke: a randomized, single-blind clinical trial. Age Ageing. Feb 27 2020; 49(2): 246-252. PMID 31846499
  10. Wu YT, Yu HK, Chen LR, et al. Extracorporeal Shock Waves Versus Botulinum Toxin Type A in the Treatment of Poststroke Upper Limb Spasticity: A Randomized Noninferiority Trial. Arch Phys Med Rehabil. Nov 2018; 99(11): 2143-2150. PMID 30392753
  11. Vidal X, Morral A, Costa L, et al. Radial extracorporeal shock wave therapy (rESWT) in the treatment of spasticity in cerebral palsy: a randomized, placebo-controlled clinical trial. NeuroRehabilitation. 2011; 29(4): 413-9. PMID 22207070
  12. Marwan Y, Husain W, Alhajii W, et al. Extracorporeal shock wave therapy relieved pain in patients with coccydynia: a report of two cases. Spine J. Jan 2014; 14(1): e1-4. PMID 24094989
  13. Ahadi T, Hosseinverdi S, Raissi G, et al. Comparison of Extracorporeal Shockwave Therapy and Blind Steroid Injection in Patients With Coccydynia: A Randomized Clinical Trial. Am J Phys Med Rehabil. May 01 2022; 101(5): 417-422. PMID 34091468
  14. Jung YJ, Park WY, Jeon JH, et al. Outcomes of ultrasound-guided extracorporeal shock wave therapy for painful stump neuroma. Ann Rehabil Med. Aug 2014; 38(4): 523-33. PMID 25229031
  15. Furia JP, Rompe JD, Maffulli N, et al. Radial Extracorporeal Shock Wave Therapy Is Effective and Safe in Chronic Distal Biceps Tendinopathy. Clin J Sport Med. Sep 2017; 27(5): 430-437. PMID 27893487
  16. Thomas JL, Christensen JC, Kravitz SR, et al. The diagnosis and treatment of heel pain: a clinical practice guideline-revision 2010. J Foot Ankle Surg. 2010; 49(3 Suppl): S1-19. PMID 20439021
  17. Schneider HP, Baca JM, Carpenter BB, et al. American College of Foot and Ankle Surgeons Clinical Consensus Statement: Diagnosis and Treatment of Adult Acquired Infracalcaneal Heel Pain. J Foot Ankle Surg. 2018; 57(2): 370-381. PMID 29284574
  18. National Institute for Health and Care Excellence (NICE). Extracorporeal shockwave therapy for refractory tennis elbow [IPG313]. 2009; https://www.nice.org.uk/guidance/ipg313. Accessed April 23,
  20. National Institute for Health and Care Excellence (NICE). Extracorporeal shockwave therapy for refractory plantar fasciitis: guidance [IPG311]. 2009; https://www.nice.org.uk/guidance/ipg311. Accessed April 23, 2025.
  21. National Institute for Health and Care Excellence (NICE). Extracorporeal shockwave therapy for refractory greater trochanteric pain syndrome [IPG376]. 2011; https://www.nice.org.uk/guidance/ipg376. Accessed April 23, 2025.
  22. National Institute for Health and Care Excellence (NICE). Extracorporeal shockwave therapy for Achilles tendinopathy [IPG571]. 2016; https://www.nice.org.uk/guidance/ipg571. Accessed April 23, 2025.

500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 11 (401) 274-4848 WWW.BCBSRI.COM

  1. National Institute for Health and Care Excellence. Extracorporeal shockwave therapy for calcific tendinopathy in the shoulder. Published November 2022. https://www.nice.org.uk/guidance/ipg742. Accessed April 23, 2025.

    i

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