Medicare covers shockwave therapy for kidney stones but generally does not cover it for musculoskeletal conditions like plantar fasciitis or tendon problems, and has no coverage policy at all for its use in treating erectile dysfunction. The answer depends entirely on what condition you’re being treated for, because Medicare evaluates shockwave therapy differently for each use.
Kidney Stones: Covered by Medicare
Shockwave lithotripsy for kidney stones is the one clear-cut case where Medicare says yes. This treatment uses a device called a lithotriptor to generate shock waves outside your body that break up stones in the upper urinary tract. The waves are focused on the stones using X-ray imaging, pulverizing them through repeated shocks so the fragments can pass naturally. Medicare has a National Coverage Determination confirming this is covered for upper urinary tract kidney stones, meaning it applies uniformly across the country regardless of which Medicare contractor processes your claim.
As with all Medicare-covered services, the treatment must be considered “reasonable and necessary” for diagnosing or treating your condition. Your doctor needs to document why the procedure is medically needed. Screening or exploratory use without documented signs, symptoms, or a personal history of kidney stones would not qualify.
Musculoskeletal Conditions: Generally Not Covered
For conditions like plantar fasciitis, tennis elbow, shoulder tendon problems, and patellar tendinopathy, Medicare’s stance is far less favorable. Shockwave therapy has been proposed as a treatment for a range of musculoskeletal issues, including calcific tendinopathy of the shoulder, lateral and medial epicondylitis (tennis and golfer’s elbow), carpal tunnel syndrome, greater trochanteric pain syndrome, fractures with delayed healing, and osteonecrosis of the femoral head.
However, the Local Coverage Determination (LCD L38775) that governs shockwave therapy in several southeastern states explicitly states that high-energy shockwave therapy is “not reasonable and necessary for the treatment of musculoskeletal conditions and therefore not covered.” This determination was revised as recently as September 2024 and still maintains that non-coverage position. While LCDs technically apply only to certain regional Medicare contractors, the pattern across the country is similar: most Medicare Administrative Contractors do not cover shockwave therapy for these uses.
If you’ve been dealing with chronic heel pain or a stubborn tendon injury, this means the treatment your doctor may recommend is one you’d likely pay for out of pocket. Individual sessions can cost $500 or more, and most treatment plans involve multiple sessions.
Erectile Dysfunction: No Coverage Policy Exists
Low-intensity shockwave therapy has gained popularity as a treatment for erectile dysfunction, but Medicare has no published coverage policy for it. That’s a distinct category from being explicitly denied. Medicare has made clear decisions about some ED treatments: penile implants are covered, while vacuum devices and oral medications like Viagra are specifically excluded. Shockwave therapy for ED falls into a gap where Medicare simply hasn’t weighed in.
The American Urological Association considers shockwave therapy for ED investigational, giving it only a conditional recommendation. Without both a formal coverage policy and strong clinical backing, Medicare claims for this use are very likely to be denied. Cleveland Clinic describes the current situation as “pay-as-you-go,” with the hope that insurance coverage may change in the future as more evidence accumulates.
What You’ll Pay Without Coverage
When Medicare doesn’t cover shockwave therapy, the full cost falls to you. Sessions typically run $500 or more each, and treatment protocols for musculoskeletal conditions or ED often call for a series of sessions spread over several weeks. A complete course of treatment can easily reach $2,000 to $3,000 or higher depending on your provider and location.
Medicare Advantage plans (Part C) must cover everything Original Medicare covers, but they can also offer additional benefits. In practice, most Medicare Advantage plans follow the same coverage limitations as Original Medicare for shockwave therapy on musculoskeletal conditions and ED. It’s worth calling your specific plan to ask, but don’t expect a different answer for these uses. For kidney stone treatment, both Original Medicare and Medicare Advantage plans provide coverage.
Alternatives Medicare Does Cover
If you’re considering shockwave therapy for a musculoskeletal problem, several alternative treatments are covered by Medicare. Physical therapy is covered under Part B for conditions like plantar fasciitis, tendinopathy, and chronic pain. Corticosteroid injections administered in a doctor’s office are also typically covered. For foot-related conditions, Medicare’s braces benefit covers ankle-foot orthoses, and orthopedic footwear that’s part of a brace is included as well. Custom orthotics that are components of a covered brace fall under this benefit, though simple shoe inserts that don’t extend above the ankle are classified as foot orthoses and have different coverage rules.
For many of these conditions, doctors are required to try conservative approaches before recommending more advanced procedures anyway. Stretching programs, physical therapy, orthotics, and injections resolve the majority of plantar fasciitis cases without ever needing shockwave therapy. If you’ve exhausted these options and your doctor recommends shockwave treatment, understanding that you’ll likely pay out of pocket lets you plan accordingly and shop around on price, since costs vary significantly between providers.