How do I bill for low-level laser therapy?
By Marty Kotlar, DC, CHCC, CBCS

I just purchased a low-level laser therapy device. The equipment manufacturer recommends I use therapeutic procedure codes, but didn’t specify which ones. I’ve also heard that most insurance carriers do not pay for this type of therapy. Do you have any recommendations?

The term low-level laser therapy (LLLT), also referred to as “cold laser therapy,” refers to a wide variety of procedures involving several laser types and treatment methods.

I do not recommend using the following therapeutic procedure codes:

• 97110 — Therapeutic procedures, one or more areas; therapeutic exercises to develop strength and endurance, range of motion, and flexibility;

• 97112 — Therapeutic procedures, one or more areas; neuromuscular re-education of movement, balance, coordination, kinesthetic sense, posture, and proprioception; or

• 97530 — Therapeutic activities, direct hands-on; use of dynamic activities to improve functional performance with direct contact by the provider.

Instead, I recommend you call the patient’s insurance carrier and ask if LLLT is a covered service.

Unfortunately most carriers consider LLLT a noncovered service. One major insurance company says this about LLLT:

“Cold laser therapy is considered experimental and investigational because there is inadequate evidence of the effectiveness of low-energy (cold) lasers in wound healing, pain relief, or for other indications, such as physical therapy, musculoskeletal dysfunction, arthritis, and neurological dysfunctions.”

Another insurer says:

“Low-level laser therapy (LLLT) has been proposed for a wide variety of uses including wound healing, tuberculosis, and musculoskeletal conditions, such as osteoarthritis, rheumatoid arthritis, fibromyalgia, and carpal tunnel syndrome.

“There is insufficient evidence in the peer-reviewed literature to conclude that LLLT is effective for these conditions or other medical conditions. Large, well-designed clinical trials are required to demonstrate the effectiveness of LLLT for the proposed conditions.

“At this time, the use of LLLT for all conditions remains experimental, investigational, and unproven.”

When you bill an insurance carrier for LLLT, use CPT code 97039 (unlisted modality; specify type and time if in constant attendance) and submit a written report with the claim.

If the carrier (such as Blue Cross/Blue Shield) prefers a HCPCS code, use S8948 (application of a modality to one or more areas; low-level laser; each 15 minutes).

Also, if a Medicare patient requests you submit the claim for LLLT, send the claim to Medicare and use your local Medicare carrier’s recommended CPT code for LLLT (with the GPGY modifiers for denial purposes. GP stands for “services delivered under an outpatient physical therapy plan of care.” GY stands for “items or services statutorily excluded or does not meet the definition of any Medicare benefit.”).

This is important, because you want the Medicare EOB to have the “PR” remark, which indicates “patient responsibility” — not the “CO” remark that indicates “contractual obligation.”

Marty Kotlar, DC, CHCC, CBCS, is president of Target Coding. Target Coding, in conjunction with Foot Levelers, offers continuing-education seminars on CPT coding and compliant documentation. He can be reached at 800-270-7044, by e-mail at drkotlar@targetcoding.com, or through his Web site, www.targetcoding.com.