Is Shockwave Therapy Covered by Insurance? What You Should Know

Thinking about shockwave therapy for your health? You might wonder, "Is shockwave therapy covered by insurance?" This guide will help you understand this. Whether your insurance covers it depends on your provider and policy. 

Imagine finally finding a solution to that persistent pain, neuropathy, tendinitis or injury, only to wonder if your insurance will cover it. Shockwave therapy is gaining traction as a highly effective treatment for conditions like tendinitis, plantar fasciitis, frozen shoulder, Achilles tendinitis, tennis elbow, and carpal tunnel syndrome.  But for many, the big question remains—can you get this cutting-edge therapy without breaking the bank, whether you can use your insurance benefits or you are paying out of pocket?

The good news? More insurance companies are recognizing the value of shockwave therapy, and it might just be more accessible than you think. Understanding what your policy covers could unlock relief for chronic pain that’s been holding you back for too long.  Insurance companies like Aetna and Blue Cross Blue Shield will pay for the office visit portion of your shockwave therapy visit but not the actual procedure. 

Don’t let the fear of cost stand between you and a pain-free life. Discover the key factors that could make shockwave therapy affordable, and why now might be the perfect time to explore a local provider to get started on your recovery journey.  Many shockwave therapy providers like orthopedic doctors, chiropractors or physical therapy offices offer discounted self-pay packages.  This means that you can pay anywhere from $99-$150 per visit instead of $175-$250 if you are just paying as you go.  Like with many medical offices for PT, MRI's, PRP injections, stem cell injections and even massage therapy; you can pre-pay up front and they will give you a cash discount.  Discounts on medical services and procedures can only be given if medical insurance is not involved; this seems to be the case for most patients seeking out shockwave therapy services. 

 

Key Takeaways

  • Most insurance companies do not cover shockwave therapy, especially for conditions not widely recognized in the medical community.  This is slowly improving; it helps when patients call their insurance company and let them know the significant improvements they are seeing with shockwave therapy.  Keep in mind shockwave therapy companies like StemWave and SoftWave have FDA approval.  You hear about shockwave therapy being "experimental" but it is moving quickly toward being mainstream. 
  • The coverage of shockwave therapy by insurance depends on individual insurance providers and specific policy details.  Insurance companies like Aetna and Blue Cross Blue Shield will often times cover the cost of the office visit. 
  •  Different insurance plans offer varying coverage for shockwave therapy.  Some auto policy insurance may cover the cost of shockwave therapy for car accident patients.  Insurance like Med-Pay or Personal Injury Protection, (PIP), can sometimes pick up the cost of the extracorporeal shockwave therapy treatment, (EWST).  If in a car accident, you would just need to call your insurance agent, or insurance provider like Geico, USAA, Progressive, Farmers, Travelers or Nationwide to see what they all cover. 
  • Healthcare providers may provide discounts for upfront payment or offer payment plans for shockwave therapy.  Most shockwave therapy providers are orthopedic doctors, sports medicine doctors, chiropractors or physical therapy clinics; they will often offer discount of shockwave therapy sessions for packages of 10 or 20 visits.  If you buy a package of visits, you can save 30-40%, rather than just paying per visit.  The average cost of a shockwave therapy session in the Houston area is $125-$175 per visit.  Offices offering packages of 10 or more can bring the cost down to $99-$125 per visit. 
  • Shockwave therapy is becoming the go to choice for non-invasive treatments of tendinitis, inflammatory conditions, chronic pain and sports injuries.  When patient see remarkable improvements in their condition after just a few sessions; they are willing to pay out of pocket. 
  • Due to the fact that shockwave therapy is getting so much attention for healing chronic aches and pains, more people are asking, is shockwave therapy covered by insurance. We are hoping as time goes on, says Dr. Hamel of Hamel Chiropractic and Wellness in Kingwood, Texas; that more insurance companies will recognize the benefit of this treatment and how it can really cut down on potential costs for Cortisone shots or even surgeries.  The amount of money that insurance companies spend every year for chronic pain patients for medication, Cortisone shots and surgeries is in the billions of dollars. 

What is Shockwave Therapy?
Shockwave therapy, also known as Extracorporeal Shockwave Therapy (ESWT), is a non-invasive treatment that is being done in the offices of chiropractors, physical therapist and orthopedic doctors.  It uses high-energy sound waves to help enhance healing and reduce pain. This therapy is becoming more and more popular in orthopedics, chiropractic, physiotherapy, and sports medicine for treating many musculoskeletal and extremity issues.  The most common issues treated by ESWT today are frozen shoulder, rotator cuff tears, bursitis, lateral epicondylitis, golfer's elbow, knee osteoarthritis, Achilles tendinitis and plantar fasciitis. 

The Science Behind the Treatment
The science behind shockwave therapy makes it highly effective. High-energy acoustic waves travel faster than sound, causing a biological healing response in tissues. This stimulates the body's natural healing process, it helps to improve blood flow, and reduce inflammation and scar tissue.

Benefits of Shockwave Therapy

  • Pain relief and improved healing for conditions like tendinitis, plantar fasciitis, and muscle injuries.  Every patient who is dealing with chronic pain is looking for pain relief, using ESWT it doesn't just mask the pain like medicine does; it actually gets to the root cause of the problem and helps heal it. 
  • Increased blood flow and circulation, speeding up the body's healing process.  Often times injuries are located in areas where there is not very good blood flow like the meniscus of the knee, the supraspinatus and infraspinatus of the rotator cuff, the Achilles tendon, the IT band, and the plantar fascia.  Increased blood flow brings oxygen and other healing cells in to the area; this is key when it comes to recovering and healing from an injury. 
  • Stimulation of bone and tissue regeneration, helping repair damaged structures. Shockwave therapy brings in growth factors like VEGF and BMP's which promotes the formation of new blood vessels; this is why it works so well with bone healing and soft tissue regeneration. 
  • Reduction of inflammation and the breakdown of calcifications or trigger points.  ESWT helps to regulate inflammatory mediators, realize that chronic inflammation is another major barrier to healing.  We all know of inflamed and swollen ankle sprains and knee sprains that seem to take forever to go away; this is because inflammation interferes with healing. 

Shockwave therapy is a versatile treatment for many musculoskeletal and extremity injuries. It offers a non-invasive and natural boost to your body's ability to heal and repair for pain and mobility issues like frozen shoulder, Sciatica, and knee meniscal tears.  
 

"Shockwave therapy has been a game-changer for my patients. It's a safe, effective, and relatively quick treatment that can help them get back to their active lifestyles without the need for surgery or long recovery times."

Is Shockwave Therapy Covered by Insurance
Shockwave therapy's insurance coverage is complex. In the U.S., most health insurance doesn't cover it. This is because it's seen as an elective or experimental treatment for some conditions.  Shockwave manufacturers like StemWave and SoftWave have already had their devices FDA approved for certain tendinitis treatments for the plantar fascia and Achilles tendon, so they are moving in the right direction.  Despite its proven benefits for issues like plantar fasciitis and Achilles tendinitis, many insurers don't see it as essential. This means patients might have to pay for it themselves, which can be expensive.  But, insurance coverage for shockwave therapy can differ. It depends on your plan and the condition being treated. Some insurers might cover it, but with limits. Always check with your provider to know what's covered and what's not.  Keep in mind if all shockwave therapy procedures were FDA approved and considered mainstream, it would be a significant cost for insurance companies to cover.  Although by insurance companies covering ESWT for conditions like knee pain, shoulder pain, carpal tunnel and plantar fasciitis, they would save billions of dollars that they would otherwise be spending covering prescription medication, Cortisone shots, orthoscopic surgeries and joint replacement surgeries. 

"Shockwave therapy is not currently covered by health insurance, which means patients may have to pay for the treatment out of pocket. However, the cost can vary depending on the provider and the specific condition being treated."
 

The cost of shockwave therapy also varies. Some providers offer deals or financing to help. Others might work out payment plans or discounts with patients.  Patients spend thousands of dollars on other procedures like plastic surgery, stem cell therapy, and dental work, these are all elective procedures that insurance will never cover; millions of people get these procedures done every year. If you had a chance to prevent knee or hip surgery by using shockwave therapy, would it be worth it?  If you could get back on the pickleball court in 6 weeks by doing ESWT on your plantar fasciitis, would it be worth the cost?  If you had frozen shoulder, (which no medical profession has figured out how to fix), and in 2 weeks you could move your shoulder 50% more because of ESWT, would it be worth the cost?  If you had bone on bone knee pain and osteoarthritis and you could prevent total knee replacement surgery for 2 years; would it be worth the cost?

In short, while insurance usually doesn't cover shockwave therapy, it's worth exploring your options. Talk to your insurance and healthcare team to understand costs and possible coverage. With the right information, you can decide if shockwave therapy is right for you.

Factors Influencing Insurance Coverage
Insurance coverage for shockwave therapy can be a big deal. It affects how much you pay out of pocket. Knowing what influences insurance coverage is key to getting the care you need.  If your Aetna or Blue Cross plan covers some of the visit; that is awesome; any little bit helps. 

Type of Insurance Plan
Your insurance plan type matters a lot. Some plans see shockwave therapy as necessary, while others don't. Deductibles, co-payments, and coverage limits all play a part in what you pay.  If you have any questions, make sure to call your insurance company, talk to an agent and tell them exactly what treatment you are interested in getting, and ask them why shockwave isn't covered or when it will be. 

Insurance Provider's Policy
Insurance providers have their own rules too. They decide if shockwave therapy is needed. Knowing their rules and any extra steps you might need is important.  It is very true, all insurance companies are different, some cover certain musculoskeletal treatments while other don't; it doesn't make a lot of sense but they make the rules. 

Factors Influencing Insurance Coverage Potential Impact
Type of Insurance Plan Determines the level of coverage for shockwave therapy, including deductibles, co-payments, and maximum coverage limits.
Insurance Provider's Policy Evaluates the medical necessity and appropriateness of shockwave therapy, potentially requiring prior authorization.

Knowing these factors helps you answer the question; "is shockwave therapy covered by insurance". Being informed lets you work with your healthcare team. This way, you can get the support you need for this treatment.  Remember for most medical services, including shockwave therapy, PRP, Ozone therapy and more; you can pay out of pocket.  There are many alternative therapies out there that will never be covered by insurance, but they are very effective in what they are trying to accomplish. 

How to Check Coverage and Get Approval
Understanding insurance for shockwave therapy can be tough. But, with the right steps, you can get the care you need. Start by reviewing your insurance policy carefully. Know your deductibles, co-pays, and any limits or exclusions for shockwave therapy.

Consult Your Insurance Provider
After reviewing your policy, contact your insurance provider directly. Talk to a customer service rep about your shockwave therapy coverage. Be ready to share details about your treatment and the doctor's recommendation.

Speak With Your Healthcare Provider
Also, work closely with your healthcare provider. They know the insurance world well and can help. They might help with paperwork or talk to the insurance company for you.  The healthcare provider can recommend shockwave therapy, but it is ultimately your insurance company that decides whether they will cover it or not. 

By following these steps, you can boost your chances of insurance approval for shockwave therapy. Remember, being persistent and detailed is crucial in healthcare coverage.

"Understanding your insurance coverage is crucial to ensuring access to medical treatments and avoiding financial burdens post-treatment."

Shockwave Therapy Costs Without Insurance
If your insurance doesn't cover shockwave therapy, you'll have to pay yourself. The price can change based on where you are, how bad your condition is, and how many sessions you need. In the greater Houston area, a single session might cost between $125-$175, but it can vary.  Shockwave therapy sessions, says Dr. Hamel, depend on the severity of the injury or condition.  Patients coming in with tendinitis and inflammation are considered uncomplicated cases and see significant improvement and healing within 6-8 weeks and 10 ESWT session.  Patients coming in trying to prevent or hold off knee replacement surgery, are considered more complicated and can take 90-120 days of care and 20-24 ESWT sessions. 

Understanding the Pricing
Several things affect the cost of shockwave therapy. These include the type of therapy, the skill of the medical team, and the equipment used. Focused shockwave therapy is usually pricier than radial therapy. Also, the number of sessions needed, whether you are buying a package of 10 or just paying as you go; this makes a difference in cost.  The two best manufacturers of shockwave therapy are StemWave and SoftWave; there machines are the best and are very costly for the provider.  If you are seeking out a local shockwave therapy provider for your chronic pain or injury, make sure they are using with StemWave or SoftWave shockwave therapy. 

Comparing Costs with Other Treatments
It's good to compare shockwave therapy costs with other treatments. Although it might seem pricey at first, it could save money in the long run. It can avoid more serious procedures or long-term meds. People can usually get back to their active life in 4 to 16 weeks, which is a big plus compared to surgery.  Surgeries and long-term prescription medicine can ben in the thousands of dollars or more.  With these invasive treatments like surgery or pain management, you are never guaranteed to feel better or pain free; this is always something to consider. 

Payment Plans and Financing Options
Some providers offer payment plans and financing to help make therapy more affordable. This can include paying in installments or using third-party financing. It's best to talk to your healthcare provider about these options to find what works best for you.

Cost Factors Range
Cost per Shockwave Therapy Session $125 to $175
Number of Recommended Sessions 10-24
Initial Consultation Fees $50 to $150
Additional Expenses (e.g., TENS, follow-up appointments) $30 to $50

The cost of shockwave therapy can really vary. It depends on the provider, location, and treatment plan. Prices in southern California average $250 per session while prices in Houston average $125 per shockwave therapy session. Always talk to your healthcare provider to get a clear cost estimate and see what payment options are available.

Conclusion
Shockwave therapy is not usually covered by insurance. But it can be a natural and affordable way to treat many orthopedic injuries and chronic pain. By understanding how insurance works, compare you options for treatment and other therapies and choose what you think is best for you.  If you are more sedentary that pain injections or surgery might be the best choice.  If you plan to be more active, gardening, pickleball, golf or hiking then a more alternative therapy like shockwave might be your best bet.   Studies show that shockwave therapy works well for many muscle and bone problems. These include shoulder tendinopathy, lateral epicondylitis, plantar fasciitis, and knee osteoarthritis. Whether insurance covers or not, it is becoming one of the most popular choices among doctors and patients. Shockwave therapy might be a good choice if you want to avoid the side effects of drugs or surgery.  These days, says Dr. Hamel, many patients are looking for less invasive procedures or medicine; they are frustrated at just taking another pill or having another orthoscopic surgery.  Shockwave therapy gives them another option, sound waves go into the injured area and create a healing response; the patient doesn't have to worry about long healing times after surgery or getting addicted to strong medication. 

FAQ
Is shockwave therapy covered by insurance?
Whether your insurance covers shockwave therapy depends on your policy. Most insurance companies don't cover it, especially for less common conditions. Always check with your provider to see what's covered.  The FDA has approved shockwave therapy from StemWave for plantar fasciitis and Achilles tendinitis treatment so this definitely carries some weight.  However, it is up to the insurance company to decide whether it is an experimental therapy or not. 

What types of insurance cover shockwave therapy?
Your insurance plan and provider's policies affect coverage. Different plans offer varying levels of coverage. Some plans through Aetna and Blue Cross Blue Shield cover part of the office visit. 

Is ESWT (extracorporeal shockwave therapy) covered by insurance?
Like shockwave therapy, ESWT coverage varies by insurance and policy. Most don't cover it, especially for rare conditions. It's crucial to confirm with your provider about your coverage.

Why is shockwave therapy so expensive?
The manufacturers of shockwave therapy, StemWave and Softwave have invested millions of dollars into research and development.  This is why their shockwave therapy units cost upwards of $60,000.  The results and treatment outcomes of ESWT are nothing short of spectacular, there has never been a non-invasive, healing therapy that can work as quickly and conveniently.  Shockwave therapy will be done at the office of a chiropractor, physical therapist, or orthopedic doctor; you do not need a referral, there are no needles, and you do not need to be put under anesthesia.  For these reasons, shockwave therapy providers can offer this service at a fair value; the average cost in the greater Houston area for ESWT is $125 per session; in California it is closer to $225.  When we talk about the expense of it; we have to consider, compared to what?  In Texas, the average cost of a Cortisone shot is $225, PRP injection, (platelet rich plasma), is $989, Physical therapy is $169, orthoscopic surgery for knee is $7000, orthoscopic shoulder surgery is $6800, full knee replacement surgery is $35000, hip replacement surgery $23000, carpal tunnel surgery $3000, Achilles tendon surgery is $10000, and plantar fasciitis surgery is $7000.  Consider that some women choose to get a mommy make over using plastic surgery, they pay $17000.  People should only get shockwave therapy if they want to be active, pain free and want to avoid surgery.  It is a fairly inexpensive investment to get your health and livelihood back. 

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