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Extracorporeal shock wave therapy (ESWT), also known as orthotripsy, is a non-invasive treatment modality utilized for various conditions affecting the musculoskeletal system. This procedure employs high-energy shock waves to target specific areas of the body, aiming to alleviate pain and enhance the healing process. ESWT is particularly beneficial for patients suffering from conditions such as plantar fasciitis, Achilles tendinitis, patellar tendinitis, and various tendinopathies affecting the shoulder and elbow joints. Additionally, it is indicated for stress fractures, delayed healing in union or non-union fractures, and avascular necrosis of the femoral head. The underlying mechanism of ESWT involves the disruption of calcium deposits and scar tissue that can accumulate in inflamed areas, which may restrict movement and exert pressure on surrounding tissues, including nerves and blood vessels. By delivering shock waves, the therapy promotes the re-absorption of calcium, facilitates the breakdown of scar tissue, reduces inflammation, and ultimately supports tissue healing. The procedure is typically performed under local, regional, or general anesthesia, ensuring patient comfort throughout the treatment. The area of tenderness is identified and marked while the patient remains awake and alert, followed by the application of a viscous ultrasound gel to enhance the transmission of shock waves. The treatment head, filled with water, is then firmly coupled to the skin, allowing for the effective delivery of shock waves to the targeted musculoskeletal area. The use of CPT® Code 0101T specifically denotes ESWT applied to an area of the musculoskeletal system that is not otherwise specified, distinguishing it from other codes that may apply to more specific conditions or anatomical sites.
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Extracorporeal shock wave therapy (ESWT) is indicated for the following conditions:
The procedure for extracorporeal shock wave therapy (ESWT) involves several key steps to ensure effective treatment:
After the completion of extracorporeal shock wave therapy (ESWT), patients may experience some mild discomfort or soreness in the treated area, which is generally temporary. It is important for patients to follow any post-procedure care instructions provided by their healthcare provider, which may include recommendations for rest, ice application, and gradual return to normal activities. Patients are typically advised to monitor the treated area for any unusual symptoms and to report any concerns to their healthcare provider. Follow-up appointments may be scheduled to assess the effectiveness of the treatment and to determine if additional sessions are necessary for optimal healing and pain relief.
| Short Descr | ESW MUSCSKEL SYS NOS | Medium Descr | EXTRACORPOREAL SHOCK WAVE MUSCSKEL SYS NOS | Long Descr | Extracorporeal shock wave involving musculoskeletal system, not otherwise specified | Status Code | Carriers Price the Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Multiple Reduction Applies | ASC Payment Indicator | Office-based surgical procedure added to ASC list in CY 2008 or later without MPFS nonfacility PE RVUs; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P6C - Minor procedures - other (Medicare fee schedule) | MUE | 1 | CCS Clinical Classification | 163 - Other non-OR therapeutic procedures on musculoskeletal system |
| GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GA | Waiver of liability statement issued as required by payer policy, individual case | LT | Left side (used to identify procedures performed on the left side of the body) | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | RT | Right side (used to identify procedures performed on the right side of the body) | GP | Services delivered under an outpatient physical therapy plan of care | GX | Notice of liability issued, voluntary under payer policy | AT | Acute treatment (this modifier should be used when reporting service 98940, 98941, 98942) | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | CQ | Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant | GO | Services delivered under an outpatient occupational therapy plan of care | GZ | Item or service expected to be denied as not reasonable and necessary | KX | Requirements specified in the medical policy have been met | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2022-01-01 | Changed | Code description changed. |
| 2013-01-01 | Changed | Guideline information changed. |
| 2011-01-01 | Changed | Short description changed. |
| 2006-01-01 | Added | First appearance in code book in 2006. |
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