Low-level laser therapy (LLLT) has rapidly gained popularity among DCs and other healthcare professionals alike, due to its noninvasive nature and impressive therapeutic benefits.
Also known as cold laser therapy, it is a form of phototherapy that uses a device to produce laser beam wavelengths, typically between 600-1000 nanometers (nm) and watts from 5-500 milliwatts (mW). Utilizing its lasers or light-emitting diodes, Low-level laser therapy stimulates cellular function and promotes healing, making it an attractive option for treating a variety of conditions, such as chronic pain and inflammation. Because it can provide effective pain relief without the need for medication, it has become a popular choice in chiropractic practices. It is often used to treat the following:
- Inflammatory conditions (rheumatoid arthritis, carpal tunnel syndrome, bursitis)
- Pain management (fibromyalgia, bursitis, myofascial pain, fasciitis)
- Connective tissue injury (tendinitis, tendon ruptures, sprains)
- Joint or muscle injury (dislocations, osteoarthritis, muscle ruptures)
Ready, fire, aim
Because of its popularity, implementation of this therapy has grown exponentially in practices around the U.S. However, offices often fail to perform due diligence when offering LLLT around the concepts of medical necessity, billing and coding when a third-party payer is involved. And, even if the service is not covered, there are rules to follow to be able to charge cash for the service. Some of these rules are enforced by state boards. Missteps in this area can cost the practice time and money. As with any service rendered in the practice, a four-step process is mandatory to ensure that reimbursement from a third-party payer (or even the patient) is allowed.
- Eligibility: If the patient is insured, are they eligible for benefits on the date of service? This is easily checked online or with a call to the payer.
- Benefit: Does the patient have a benefit that allows for low-level laser therapy? There are a few steps to this check. The first is to know the benefit when the service is ordered or delivered by a DC. Sometimes that requires a call. The next is to confirm whether LLLT is considered medically necessary by the payer, as found in the medical review policy (MRP) for LLLT.
- Medical necessity/MRP confirmation: Providers must find and review the MRP for any service provided in the practice, for that payer. MRPs can usually be found on the payer’s website with a simple search. It’s here that we find coding requirements and the payer’s policy on the service.
- Coding and status: Often, LLLT is deemed “experimental, unproven and investigational” and regardless of what the provider thinks may help the patient, the service wouldn’t be covered. The good news is that when you know this after conducting this due diligence, you may be able to pass that cost along to the patient with advance notice. If the service is covered, the MRP clarifies which code they expect the provider to use to describe LLLT.
CPT® code selection means something
Until recently, there were CPT codes to describe LLLT, and providers had to use unlisted codes, such as 97039 or 97139. Some payers did allow the use of S8948; in July 2019, another code option (0552T) became available (see Table A).
Before you get too excited and start billing 0552T, look carefully at the following keywords in its description: dynamic photonic and dynamic thermokinetic energies. Your device must meet both criteria. If you are unsure, check with the manufacturer before billing.
Regardless of the code used, many payers have historically denied payment for these services as mentioned above. They often base this policy on what the Centers for Medicare and Medicaid Services (CMS) has to say about it. CMS’ National Coverage Determination (NCD) 270.6 states: “The use of infrared and/or near-infrared light and/or heat, including monochromatic infrared energy (MIRE), is not covered for treatment, including symptoms, such as pain arising from these conditions, of diabetic and/or non-diabetic peripheral sensory neuropathy, wounds and/or ulcers of skin and/or subcutaneous tissues in Medicare beneficiaries.”
It should be noted that code 0552T has been assigned category “M” by Medicare and is defined as “Items and Services Not Billable to the MAC. Not paid under OPPS.” Therefore, Medicare won’t pay for it, and it appears that others follow Medicare’s lead. The best plan is to use the most applicable code allowed by the payer that meets the code definitions.
Patient acknowledgment to self-pay
When ordering or delivering low-level laser therapy, it’s critical to perform the four steps mentioned above. Then, it’s critical to communicate that to the patient so they can opt-in and self-pay for the service. Without this acknowledgement, you may not be able to pass the cost along to the patient.
Some payers have their own form required when a service is considered experimental/unproven and investigational. The patient must sign that form and agree to pay prior to the service being offered. You can see the potential disaster when a practice doesn’t complete those four steps, and then gets left holding the (empty) bag because they can’t collect for the service. These are simple business practices that must be included in the standard operating procedure (SOP) for the practice. In the absence of a specific form from the payer, a practice can fashion their own form with the requisite information.
Final thoughts on low-level laser therapy coding
Expanding your treatment options to include LLLT in the practice is a wonderful option for patients. Providers consistently see excellent results in patients, and it can also be an effective cash profit center for the practice when managed correctly. As with all services, be sure your data-gathering process includes checking eligibility, confirming the benefit for LLLT, finding the medical review policy and verifying coding and experimental status. These “laser focused” steps will ensure your patients get what they need, and you are properly reimbursed for your services.
KATHY (KMC) WEIDNER, better known professionally as Kathy Mills Chang, is a Certified Medical Compliance Specialist (MCS-P), a Certified Professional Compliance Officer (CPCO) and a Certified Chiropractic Professional Coder. Since 1983, she has been providing DCs with reimbursement and compliance training, advice and tools to improve the financial performance of their practices. This year, celebrating serving this profession for 41 years, Weidner leads the largest team of certified specialists under one roof in the profession at KMC University. She is one of our profession’s foremost experts on Medicare and documentation. She or any of her team members can be reached at 855-TEAM-KMC or info@KMCUniversity.com.
