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Prior Authorization

Bone Growth Stimulators

Non-invasive (ultrasonic or electrical) bone growth stimulators may be covered by the South Dakota Medical Assistance program for skeletally mature individuals if one of the following conditions are met and written prior authorization has been obtained.  The nonunion cannot be related or due to malignancy.

  1. There is a nonunion of a long bone fracture and the fracture gap is less than or      equal to 1 cm and it is greater than 90 days from the date of injury or initial treatment and cessation of healing is documented by 2 sets of radiographs with multiple views least 90 days apart;
  2. There is a failed fusion of a joint other than spine and a minimum of nine months has elapsed since the last surgery;
  3. There is congenital pseudarthrosis;
  4. Closed fractures when there is suspected high risk for delayed fracture healing or nonunion as a result of either of the following:     

    • due to location of fracture and poor blood supply (e.g. scaphoid, 5th metatarsal) or
    • presence of comorbidities likely to compromise healing (e.g. smoking, diabetes, renal disease, or other metabolic disease); or
    5. It is an adjunct to spinal fusion surgery for patients at high risk of pseudarthrosis due to a previously failed spinal fusion at the same site or for those undergoing multiple level fusions. For purposes of this authorization a multiple level fusion involves three or more vertebrae, for example: L2-L4, L3-L5, or L4-S1.                                                

Documentation Requirements for Prior Authorization Requests:

Submit completed documentation to:

  • Department of Social Services
    Division of Medical Services
    Nurse Consultant
    700 Governors Drive
    Pierre, SD 57501
  • Phone: 605-773-3495
  • Fax: 605-773-5246