Effective Date: 04/06/2011
Title: Plantar Fasciitis Treatments
Revision Date: 10/01/2015
CPT Code(s): 0101T, 0102T, 29893, 77401, 77402, 77407, 77412, 77417
will apply to all services performed on or after the above revision date which
will become the new effective date.
services referred to in this policy that were performed before the revision
date, contact customer service for the rules that would apply.
fasciitis treatment by shock wave therapy is not covered.
fasciitis treatment by radiofrequency ablation treatment is considered
experimental/investigational and not covered.
plantar fasciotomy is a covered service.
considers endoscopic plantar fasciotomy as an alternative to conventional open
plantar fasciotomy medically necessary in members with intractable plantar
fasciitis or heel spur syndrome who have failed a 6-month trial of conservative
considers extracorporeal shock-wave therapy (ESWT) with the OssaTron (HealthTronics,
Marietta, GA), the Dornier Epos Ultra (Dornier Medical Systems, Kennesaw, GA),
the Sonocur (Siemens Medical Solutions Inc., Iselin, NJ), the Orbasone Pain
Relief System (Orthometrix, Inc., White Plains, NY), the OrthospecTM
Extracorporeal Shock Wave Therapy (Medispec, Ltd., Germantown, MD), or any other
ESWT devices experimental and investigational for plantar fasciitis. Search for
BI "Extracorporeal Shock Wave Therapy (Orthotripsy)"
considers radiofrequency lesioning, radiotherapy, marrow stimulation techniques
(micro fracture, drilling), or cryosurgery (cryotherapy) experimental and
investigational for members with plantar fasciitis. There is a lack of
published literature documenting the safety and efficacy of these techniques in
the treatment of plantar fasciitis.
Codes Used In This BI:
28890 High Energy Eswt Plantar
Fascia (deleted 1-1-15)
0019T Extracorp Shockwave Tx Ms NOS (deleted 1-1-15)
0101T Extracorp Shockwave Tx Hi Enrg
0102T Extracorp Shockwave Tx Anesth
29893 Endoscopic plantar fasciotomy
77401 Rad trmt delivery, super/ortho voltage, per day
77402 Rad trmt del, =>1 MeV; simple
77407 Rad trmt del, =>1 MeV; intermed
77412 Rad trmt del, =>1 MeV; complex
77417 Therapeutic rad port film(s)
77403 Simple; 6-10 MeV (deleted 1-1-15)
77404 Simple; 11-19 MeV (deleted 1-1-15)
77406 Simple; 20 MeV or grtr (deleted 1-1-15)
77408 Itrmed; 6-10 MeV (deleted 1-1-15)
77409 Itrmed; 11-19 MeV (deleted 1-1-15)
77411 Itrmed; 20 MeV or grtr (deleted 1-1-15)
77413 Complex; 6-10 MeV (deleted 1-1-15)
77414 Complex; 11-19 MeV (deleted 1-1-15)
77416 Complex; 20 MeV or grtr (deleted 1-1-15)
77418 IMRT Delivery (deleted 1-1-15)
77421 Stereoscopic Imaging Guide (deleted 1-1-15)
fasciitis is defined as the traction degeneration of the plantar fascia at its
origin on the heel. Plantar fasciitis is the most common cause of chronic heel
pain. It is usually caused by bone spurs or inflammation of the foot`s
connective tissue and the condition may be resistant to conservative treatment.
Conservative treatments for plantar fasciitis include rest, physical therapy,
heel cushions, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroid
injections, taping, foot orthotics, shoe modifications, night splinting, and
intervention may be indicated for patients who fail conservative treatment.
Well-designed placebo- or sham-controlled clinical trials for plantar fasciitis
are especially important because: 1) most cases of plantar fascial pain resolve
spontaneously over time; and 2) pain is a symptom that is especially susceptible
to placebo effects.
Radiofrequency lesioning is used to ablate pain pathways and is generally
employed for intractable pain that has not responded to conservative measures.
Radiofrequency lesioning is not an established procedure for the treatment of
recently, extracorporeal shock wave therapy (ESWT) has been used to treat
plantar fasciitis. ESWT is thought to relieve pain by disrupting scar tissue,
causing microscopic damage to that tissue. This induces new blood vessel
formation into the injured area and facilitates the healing process.
EPOS Ultra is an ESWT system that uses electromagnetic energy to generate a
shock wave, which travels through a water-filled coupling cushion mounted to a
therapy head. The therapy head has an acoustic lens to focus the shock wave
treatment on the target tissue. The EPOS Ultra also has an ultrasound imaging
system that is used to observe and monitor the shock wave treatment. Typically,
3800 shock waves are delivered over 20 minutes.
In support of
their pre-market approval application (PMA), a randomized, double-blind,
sham-treatment-controlled study was conducted involving 150 adult patients with
chronic plantar fasciitis enrolled at 6 clinical centers. Patients had at least
moderate pain (Visual Analog Score (VAS) greater than 5) for at least six months
and a history of prior conservative therapy (including NSAIDs and two other
conservative therapies). After being randomized to active or sham treatment
groups, patients underwent a single ESWT session, and were followed for 12
months. After 3 months, patients who received sham treatment were offered
active unmasked treatment. To maintain physician blinding during the first 3
months of the study, the treatment was administered by a physician who did not
perform the follow-up evaluations.
there was a modest, statistically significant difference in improvement in VAS
pain scores from baseline (the primary study endpoint) between active and sham
treatment groups at three months, this was not accompanied by a significant
improvement of function. In the active group, the pain score decreased by an
average of 56.5% by the end of three months; in the sham group, the average pain
score decreased by 46.6%. Patients in the active group were more likely (56%)
than patients in the sham group (45%) to report an improvement in VAS pain
scores of 60% or more from baseline; however, this difference was not
Barrett SL, Day SV. Endoscopic
plantar fasciotomy for chronic plantar fasciitis/heel spur syndrome:
Surgical technique - Early clinical results. J Foot Ankle Surg.
Barrett SL, Day SV. Endoscopic
plantar fasciotomy: Two portal endoscopic surgical techniques - Clinical
results of 65 procedures. J Foot Ankle Surg. 1993;32:248-256.
Barrett SL, Day SV, Pignetti TT,
Robinson LB. Endoscopic plantar fasciotomy: A multi-surgeon prospective
analysis of 652 cases. J Foot Ankle Surg. 1995;34(4):400-406.
Tomczak RL, Haverstock BD. A
retrospective comparison of endoscopic plantar fasciotomy to open plantar
fasciotomy with heel spur resection for chronic plantar fasciitis/heel spur
syndrome. J Foot Ankle Surg. 1995;34(30):305-311.
Stone PA, McClure LP.
Retrospective review of endoscopic plantar fasciotomy. 1994 through 1997. J
Am Podiatr Med Assoc. 1999;89(2):89-93.
Brekke MK, Green DR.
Retrospective analysis of minimal-incision, endoscopic, and open procedures
for heel spur syndrome. J Am Podiatr Med Assoc. 1998;88(2):64-72.
Stone PA, Davies JL.
Retrospective review of endoscopic plantar fasciotomy--1992 through 1994. J
Am Podiatr Med Assoc. 1996;86(9):414-420.
Wander DS. A retrospective
comparison of endoscopic plantar fasciotomy to open plantar fasciotomy with
heel spur resection for chronic plantar fasciitis/heel spur syndrome. J Foot
Ankle Surg. 1996;35(2):183-184.
Landsman A. Endoscopic plantar
fasciotomy: A multi-surgeon prospective analysis of 652 cases. J Foot Ankle
Barrett SL. Endoscopic plantar
fasciotomy. Clin Podiatr Med Surg. 1994;11(3):469-481.
Wander DS. Endoscopic plantar
fasciotomy versus traditional heel spur surgery. J Foot Ankle Surg.
Kinley S, Frascone S, Calderone
D, et al. Endoscopic plantar fasciotomy versus traditional heel spur
surgery: A prospective study. J Foot Ankle Surg. 1993;32(6):595-603.
Basford JR, Malanga GA, Krause
DA, Harmsen WS. A randomized controlled evaluation of low-intensity laser
therapy: Plantar fasciitis. Arch Phys Med Rehab. 1998;79(3):249-254.
Seegenschmiedt MH, Keilholz L,
and Katalinic A, et al. Heel spur: Radiation therapy for refractory pain -
Results with three treatment concepts. Radiology. 1996;200(1):271-276.
Sollitto RJ, Plotkin EL, Klein
PG, Mullin P. Early clinical results of the use of radiofrequency lesioning
in the treatment of plantar fasciitis. J Foot Ankle Surg.
1997;36(3):215-219; discussion 256.
U.S. Department of Health and
Human Services, Food and Drug Administration (FDA), Center for Device
Evaluation and Research (CDER). PMA for HealthTronics Ossatron. Orthopedics
and Rehabilitation Devices Advisory Committee Transcript. Gaithersburg, MD:
FDA; July 20, 2000. Available at:
Application to Products
This policy applies to all health plans administered by QualChoice, both those insured by QualChoice and those that are self-funded by the sponsoring employer, unless there is indication in this policy otherwise or a stated exclusion in your medical plan booklet. Consult the individual plan sponsor Summary Plan Description (SPD) for self-insured plans or the specific Evidence of Coverage (EOC) for those plans insured by QualChoice. In the event of a discrepancy between this policy and a self-insured customer’s SPD or the specific QualChoice EOC, the SPD or EOC, as applicable, will prevail. State and federal mandates will be followed as they apply.
Changes: QualChoice reserves the right to alter, amend, change or supplement benefit interpretations as needed.