Insurance
Reimbursement and Billing
The following are the most common codes used by practitioners
of laser and LED therapy. We are not recommending any particular
codes and cannot advise you on billing issues.
S8948:
Used to denoted low level laser therapy for BCBS, this code is
not reimbursable - DO NOT USE!! This code is also not accepted
by other insurers.
97026: Infrared
The beauty of this code is that it is for infrared light therapy.
The problem with this code is that it is a code for a heat lamp.
Thus, reimbursement can be quite low, although for some practitioners,
Medicare reimburses it. To improve reimbursement, try listing
it as an attended modality or adding a -22 or an "unusual
procedural services."
Below are three ways these codes can
be used:
97026: Attended photonic stimulation
97026: Attended infrared light therapy
97026-22: Attended infrared therapy
97039: Attended Modality, Unspecified
This is a code that is also being used to bill for attended modalities.
Reimbursement is good because it is understood to take more time
than an unattended code. The problem with the code is that, being
unspecified, it is occasionally rejected by some insurance carriers
or hand audited. Make sure you have a one-page description of
the treatment if a carrier wants more information.
When the claim
form goes out it will usually say something like:
97039: Attended infrared therapy or
97039: Attended laser therapy
97032: Attended Electrical Stimulation
This is a code that many practitioners modify for laser and LED
therapy. It can be billed in a number of ways and is reimbursed
quite well. Although the CPT code will stay the same, 97032,
the description will be changed to accurately reflect the service
performed.
Below are some common ways that we have seen this
code utilized by physicians and therapists:
97032: Attended Electrical-Photonic Stimulation or
97032: Attended Electrotherapy/lR
97139: Unlisted Therapeutic Procedure
This code is for a therapeutic procedure meaning that the doctor
must have one-on-one contact with the patient. The strength of
the code is that it tells the insurance carrier that the doctor
is spending direct treatment time with the patient. The weakness
of the code is that an unlisted procedure is more likely to be
closely inspected by an insurance carrier.
Billing might look
like:
97139: Photonic Stimulation: Constant attendance
97140: Manual Therapy Techniques
This code is for a manual therapy technique meaning that the practitioner
must have one-on-one contact with the patient and perform manual
therapy. The weakness of the code is that an unlisted procedure
is more likely to be closely inspected by insurance carrier.
In this case the practitioner must be using light therapy as
an adjunct to some type of manual therapy.
Billing might look
like:
97139: Manual Therapy + Infrared
Sample Documents:
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