Medicare does not cover shockwave therapy for musculoskeletal conditions like plantar fasciitis, tendinopathy, tennis elbow, or heel pain, and it does not cover low-intensity shockwave therapy for erectile dysfunction. The one form it does pay for is extracorporeal shock wave lithotripsy, a distinct procedure that uses focused acoustic energy to break up kidney stones. Everything else in the shockwave family is treated as investigational or not medically necessary, which means beneficiaries pay the full cost themselves.
Why Musculoskeletal Shockwave Therapy Is Denied
The Centers for Medicare and Medicaid Services has never issued a National Coverage Determination for extracorporeal shock wave therapy (ESWT). In its place, regional Medicare Administrative Contractors set the rules through Local Coverage Determinations.1CMS.gov. LCD L38775 – Extracorporeal Shock Wave Therapy (ESWT)
The most prominent of these is LCD L38775, published by Palmetto GBA and most recently revised in September 2024. It states that high-energy ESWT is “not reasonable and necessary for the treatment of musculoskeletal conditions and therefore not covered.”2CMS.gov. LCD L38775 – Extracorporeal Shock Wave Therapy (ESWT) The stated reason is that clinical evidence varies too much in protocol, dosing, and study design to establish that the therapy is safe and effective.
Conditions specifically named as non-covered include:
- Calcific tendinopathy of the shoulder
- Elbow tendinopathy (tennis elbow and golfer’s elbow)
- Carpal tunnel syndrome
- Greater trochanteric pain syndrome
- Fractures, delayed unions, and nonunions
- Osteonecrosis of the femoral head
- Patellar tendinopathy
Plantar fasciitis is not listed by name, but the denial extends to musculoskeletal conditions broadly, and no LCD or NCD provides a coverage pathway for ESWT on heel pain. In regions where a MAC has not published its own LCD, that silence does not create coverage. The general Medicare standard requiring services to be “reasonable and necessary” under Section 1862(a)(1)(A) of the Social Security Act still governs, and claims for musculoskeletal ESWT are denied nationwide.3CMS.gov. Billing and Coding: Extracorporeal Shock Wave Therapy (ESWT)
Low-intensity shockwave therapy for erectile dysfunction, sometimes marketed under the Gainswave brand name, is also excluded. Medicare treats it as a lifestyle enhancement rather than a medically necessary service.4Medicare.org. Does Medicare Cover Gainswave UnitedHealthcare’s 2026 medical policy reaches the same conclusion, finding “insufficient quality evidence” and calling the treatment “unproven and not medically necessary.”5UnitedHealthcare. Extracorporeal Shock Wave Therapy Medical Policy
Medicare Advantage Plans Reach the Same Result
Medicare Advantage (Part C) plans set their own medical policies but must cover at least what Original Medicare covers. Because Original Medicare does not cover ESWT, Advantage plans have no obligation to cover it, and in practice they do not. A Louisiana Blue Cross Blue Shield Advantage policy effective January 2025 classifies ESWT as “investigational” and “not reasonable and medically necessary.”6Louisiana Blue Cross Blue Shield. Extracorporeal Shock Wave Therapy Medical Policy MNG-031 Blue Cross Blue Shield of Rhode Island lists plantar fasciitis, shoulder tendinitis, Achilles tendinitis, lateral epicondylitis, stress fractures, and avascular necrosis as non-covered indications.7Blue Cross Blue Shield of Rhode Island. Extracorporeal Shock Wave Therapy for Plantar Fasciitis and Other Musculoskeletal Conditions Blue Cross Blue Shield of Massachusetts reviewed its policy in August 2025 and kept the “investigational” designation for both focused and radial protocols.8Blue Cross Blue Shield of Massachusetts. Extracorporeal Shock Wave Treatment for Plantar Fasciitis and Other Musculoskeletal Conditions
The Kidney Stone Exception
Extracorporeal shock wave lithotripsy (ESWL) is a well-established covered procedure, billed under CPT code 50590. It uses the same broad physical principle as musculoskeletal ESWT, but medically and administratively it is treated as a separate procedure. Under Original Medicare in 2026, the Medicare-approved amount for ESWL averages $2,244 at an ambulatory surgical center and $4,122 at a hospital outpatient department. After meeting the Part B deductible, the beneficiary is generally responsible for about 20 percent of that amount.9Medicare.gov. Lithotripsy, Extracorporeal Shock Wave – Procedure Price Lookup Coverage of lithotripsy for kidney stones does not extend to musculoskeletal or erectile dysfunction uses of shockwave technology.
What You Will Pay Out of Pocket
If you decide to pursue shockwave therapy for a musculoskeletal condition anyway, you will pay for it yourself. A single session typically runs between $250 and $450, with wider variation by device type and location. Radial sessions tend toward the lower end, roughly $100 to $300, while focused sessions can run $200 to $600. Most treatment plans call for three to five sessions, which puts a full course somewhere between about $600 and $3,000.10LMD Podiatry. What Is the Average Cost of Shockwave Therapy Some clinics offer package pricing or payment plans. Health Savings Account or Flexible Spending Account funds may be usable toward the expense.
Before delivering the treatment, the provider should give you an Advance Beneficiary Notice of Non-coverage (ABN). The ABN documents that Medicare is expected to deny the claim and confirms that you accept financial responsibility. Providers who skip the ABN on a non-covered service can end up liable for the bill themselves.11CMS.gov. ABN Form CMS-R-131 Tutorial
One Narrow Private-Insurer Carve-Out
Among private insurers, Aetna is an outlier. It treats ESWT as experimental for almost every condition but covers it as medically necessary for calcific tendinopathy of the shoulder when the condition has lasted at least six months, involves a calcium deposit of one centimeter or larger, and has failed to respond to conservative measures like rest, ice, and medication.12Aetna. Extracorporeal Shock Wave Therapy CPB 0649 That carve-out applies to Aetna’s commercial plans and may extend to some of its Medicare Advantage plans, though you would need to confirm with the specific plan. Original Medicare does not recognize the exception.
Appealing a Denial
If you submit a claim and it is denied, you have the right to appeal through five levels.13Medicare.gov. Medicare Appeals
- Level 1, Redetermination: filed with the MAC within 120 days of the Medicare Summary Notice. A decision generally comes within 60 days.
- Level 2, Reconsideration: reviewed by a Qualified Independent Contractor within 180 days of the redetermination notice.
- Level 3, Administrative Law Judge hearing: requires the claim to meet a minimum dollar threshold (at least $190 in recent years) and is filed with the Office of Medicare Hearings and Appeals within 60 days of the reconsideration decision. Wait times can stretch to a year or longer.14Patient Advocate Foundation. Medicare Denials and Appeals
- Level 4, Medicare Appeals Council: filed within 60 days of the ALJ decision.
- Level 5, Federal District Court: available for claims worth at least $1,900 as of 2025, filed within 60 days of the Appeals Council decision.15AARP. How to Appeal Medicare Claims
Because the denial of musculoskeletal ESWT rests on a medical-necessity determination rather than a paperwork error, appeals rarely succeed. If you file one, include the medical records, a letter from your physician explaining why the treatment was warranted in your case, and any supporting clinical literature. Free help is available through State Health Insurance Assistance Programs at shiphelp.org or by calling 1-800-MEDICARE.