Laser Therapy FAQ 1 &#; Is Laser Therapy Covered By Insurance?

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Contributed by Mark Callanen, PT, DPT, OCS

While it is true that most insurances are not reimbursing for laser therapy currently, the good news is that progress is being made. In , a HCPCS II code (S) was developed which is a specific timed code that can be used to bill for low-level laser therapy (LLLT). We recommend checking with individual insurance carriers to see if they have a fee schedule in place for this code. Medicare does not recognize the S code. For carriers that do not recognize HCPCS II codes, the appropriate ICD-10-CM Code for LLLT is , &#;Unlisted Modality&#;.

If your insurance carriers do not reimburse for this code, does that mean that a clinic cannot generate revenue providing laser therapy? Absolutely not! Many practices have embraced laser therapy as a cash option for their patients to provide leading technology for tissue healing and pain reduction.

Many patients are interested in having the ability to utilize the same technology elite athletes receive for their musculoskeletal injuries. As of today, LightForce® Lasers are currently being used in over 150 professional and collegiate training rooms. So what do they know that most private practitioners do not?

Laser therapy can be utilized as an adjunct to normal plans of care to help reduce pain and inflammation1,2. Pain is reduced in various ways with laser therapy (more correctly referred to as photobiomodulation, or PBM, therapy). Its mechanisms of action center around direct effects on afferent nerves as well as a variety of positive influences on the inflammatory cascade3,4,5,6,7,8. This is done via excitation of chromophores in the mitochondria of different cell types. Once the correct level of light energy is delivered to the tissue, mitochondrial ATP production increases9,10 along with protein synthesis11,12. These factors hasten the healing process.

The reduction of pain and inflammation will be noted by patients almost immediately and it will allow them to restore normal motion quicker. By accelerating the plan of care, functional goals should be achieved sooner resulting in a reduction of patient visits per episode. While patients will be spending slightly more for each clinic visit, they will ultimately save money by reducing the total number of visits associated with their injury. The adage &#;Time is Money&#; couldn&#;t be more accurate. The result is a win-win for the provider and the patient with quicker turn-around time for the patient and better revenue flow per visit.

References:

1. Hode, L & Turner, J , The Laser Therapy Handbook, Prima Books AB, Grangesgerb, Sweden. 2. Fregapani, P, Matos de Oliveira, M, Neto, N, Pozza, D, Sobrinho, JB, Weber, J , &#;Analgesic action of laser therapy (LLLT) in an animal model&#;, Med Oral Patol Oral Cir Bucal, vol. 13, no. 10, pp. E648-52. 3. Wakabayashi, H , &#;Effect of irradiation by semiconductor laser on responses evoked in trigeminal caudal neurons by tooth pulp stimulation&#;, Lasers in Surgery and Medicine, vol. 13, no. 6, pp. 605-610 4. Kawatani, M, Matsumoto, I, Sato, T, Takeshige, C, Tsuchiya K , &#;Diode laser irradiation selectively diminishes slow component of axonal volleys to dorsal roots from the saphenous nerve&#;, Neuroscience Letters, vol. 161, no. 1, pp. 65-68. 5. Benayahu, D, Maltz, L, Oron, U, Stein, A , &#;Low-Level Laser Irradiation Promotes Proliferation and Differentiation of Human Osteoblasts in Vitro&#;, Photomedicine and Laser Surgery, vol. 23, no. 2, pp. 161-166. 6. Abiko, Y, Sakurai, Y, Yamaguchi, M , &#;Inhibitory effect of low-level laser irradiation on LPS-stimulated prostaglandin E2 production and cyclooxygenase-2 in human gingival fibroblasts&#;, European Journal Oral Sciences, vol. 108, no. 1, pp. 29-34. 7. Greco M, Marra, E, Moro, L, Passarella, S, Perlino, E, Petragallo, VA, Vacca, RA , &#;Helium-Neon laser irradiation of hepatocytes can trigger increase of the mitochondrial membrane potential and can stimulate c-fos expression in a Ca2+-dependent manner&#;, Lasers Surgery and Medicine, vol. 29, no. 5, pp. 433-441. 8. Greguss, P, Haina, D, Mester, A, Mester, E, Nagylucskay S, Tisza S Waidelich W , &#;Effects of direct laser radiation on human lymphocytes&#;, Arch Dermatol Res, vol. 263, no. 3, pp. 241-245. 9. Casamassima, E, Catalano, IM, Cingolani, A, Molinari, S, Passarella S, Pastore D, Quagliariello E , &#;Increase of proton electrochemical potential and ATP synthesis in rat liver mitochondria irradiated in vitro by helium-neon laser&#;, FEBS Letters, vol. 175, no. 1, pp. 95-99. 10. Cui, Y, Kataoka, Y, Mochizuki, ON , &#;Effects of near-infra-red laser irradiation on adenosine triphosphate and edenosine diphosphate contents in rat brain tissue&#;, Neuroscience Letters, vol. 323, no. 3, pp. 207-210. 11. Benayahu, D, Maltz, L, Oron, U, Stein, A , &#;Low-Level Laser Irradiation Promotes Proliferation and Differentiation of Human Osteoblasts in Vitro&#;, Photomedicine and Laser Surgery, vol. 23, no. 2, pp. 161-166. 12. Mester, E, Szende, B, & Tora, JG , &#;Effect of laser on hair growth of mice&#;, Kiserl Orvostud, vol. 19, pp. 628-631.

Does Medicare Cover Cold Laser Therapy (CLT)?

By Daniel Petkevich

Jun 14,

Unfortunately, CLT is not covered

Have you ever imagined a world where light could heal? Well, welcome to the fascinating world of Cold Laser Therapy (CLT). This therapy aims to stimulate healing, alleviate pain, reduce inflammation, and restore normal cell function by using the power of specific light wavelengths. Sounds intriguing, right? However, like any treatment, the question of coverage inevitably arises. Unfortunately, Medicare currently does not cover Cold Laser Therapy.

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In this blog post, we'll explore why Medicare does not typically cover Cold Laser Therapy. We will dissect what CLT is, its potential benefits, and how insurance plays a role. We'll also provide some tips on what to do if you're interested in CLT but face the hurdle of getting it covered since it's a relatively expensive form of treatment. So, if you're seeking insights into the often perplexing landscape of Medicare coverage and alternative therapies, let's talk Cold Laser Therapy.

Understanding Cold Laser Therapy (CLT)

Cold Laser Therapy, also known as Low-Level Laser Therapy (LLLT), is a non-invasive treatment used to relieve pain and inflammation and stimulate healing in the body's tissues. Unlike high-intensity lasers used in certain medical procedures, CLT doesn't cause your tissues to heat up.

CLT works by emitting a low-intensity laser that penetrates the skin surface without causing any significant thermal damage. This light energy is absorbed by the body's tissues, where it stimulates cell metabolism, promoting the healing process. It's often used in physical therapy, chiropractic, and other therapeutic healthcare settings.

CLT has several potential benefits. It's a non-invasive method, meaning there are no incisions or wounds, reducing the risk of infection and recovery time. Moreover, the procedure is usually painless and can provide relief for a variety of conditions, including arthritis, back pain, carpal tunnel syndrome, and tendonitis.

Research into the effectiveness of Cold Laser Therapy is ongoing, with mixed results

Several studies have suggested that CLT may provide pain relief for rheumatoid arthritis and osteoarthritis. Other research has indicated its potential effectiveness in treating neck pain and temporomandibular joint disorder (TMJ).

However, while some studies suggest a moderate level of effectiveness, others have shown minimal to no effect. This discrepancy may be due to variations in the intensity and duration of the laser treatment, the area treated, and the patient's specific condition. Some people believe the effectiveness of CLT comes down to the placebo effect. CLT is not meant for everybody; remember to check with your doctor or healthcare provider before trying CLT.

The U.S. Food and Drug Administration (FDA) has cleared marketing for some low-level laser devices as adjunctive devices for temporary relief of pain. However, the FDA hasn't issued final conclusions about the effectiveness of this therapy due to the need for more comprehensive, large-scale clinical studies.

Please consult your healthcare provider for advice tailored to your specific health situation and keep up-to-date with ongoing research.

Cold Laser Therapy and Insurance

The coverage for Cold Laser Therapy (CLT) can vary greatly depending on the insurance provider. While some private insurance companies may offer partial or full coverage for CLT, especially those that include comprehensive alternative care benefits, most do not. It's essential to understand your individual policy details and to verify coverage with your insurance company before beginning treatment.

In cases where insurance does not cover CLT, patients would need to cover the costs out-of-pocket. The cost of each session can vary based on the provider, location, and specific treatment plan, among other factors. The average cost can fall between $100-$200 per session, with 3 to 5 sessions being typical treatment lengths.

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Additionally,

Health Savings Accounts (HSAs)

or Flexible Spending Accounts (FSAs) may be used to pay for CLT, but it's important to check with the plan administrator to confirm.

The primary reason some insurance companies may not cover CLT is due to its classification as an 'alternative' or 'experimental' therapy. Even though CLT has shown promise in several studies and is approved by the FDA for some specific conditions, it's not universally accepted as a standard treatment method for most conditions. Insurers often require a strong consensus within the medical community and comprehensive clinical trial data demonstrating a treatment's effectiveness before providing coverage.

Furthermore, insurance policies can vary widely, with different companies, plans, and policies offering different levels of coverage for various treatments. Factors such as whether the treatment is deemed medically necessary, the specific diagnosis, and the recommended number of treatment sessions may also influence coverage decisions.

Therefore, it's always crucial to check with your specific insurance provider to understand what is and isn't covered under your plan before you begin treatment.

Does Medicare Cover Cold Laser Therapy?

Medicare does not usually cover Cold Laser Therapy (CLT). Medicare, as a federal health insurance program, provides coverage for a wide range of medical procedures, treatments, and equipment deemed medically necessary. These typically fall under two broad categories: hospital insurance (Part A) and medical insurance (Part B).

Medicare Part B usually covers outpatient services, including durable medical equipment (DME) and a variety of treatments deemed medically necessary. However, Medicare guidelines require that the treatments and procedures covered must be recognized as safe and effective by the medical community at large. According to the

CMS

, CLT is considered by some in the medical field as an experimental or alternative treatment, and thus, it doesn't fall into the category of services generally covered by Medicare.

The main reason Medicare does not typically cover CLT lies in its classification as an 'alternative' or 'experimental' treatment. While numerous studies suggest that CLT can be beneficial for a range of conditions, from arthritis to nerve pain, it hasn't yet reached a level of universally accepted effectiveness in the broader medical community. Medicare usually requires treatments to have passed through rigorous, large-scale studies and be broadly accepted as effective by major medical associations to consider them for coverage.

Though Medicare doesn't generally cover CLT, there could be exceptions under certain circumstances, mainly if the therapy is part of a Medicare-approved clinical trial. In such cases, some of the patient's costs might be covered. Another potential scenario could be if CLT becomes more widely accepted and proven effective through comprehensive studies, prompting Medicare to revise its coverage policies in the future. Therefore, it's always worthwhile for patients to consult with their healthcare provider or a Medicare representative to explore any possible avenues for coverage.

Always remember insurance policies, including Medicare, can change over time. Thus, it is crucial to get the most recent and specific information directly from Medicare or a trusted insurance professional.

How to Get Cold Laser Therapy Covered

If your Medicare plan doesn't cover Cold Laser Therapy (CLT), you still have a few options. Firstly, you can appeal the decision. To do this, you must ask your healthcare provider to submit a written request for coverage explaining why CLT is medically necessary for your condition. Be aware that this process can be lengthy and success isn't guaranteed.

Tips on talking to doctors and insurance providers about getting coverage:

• Know your plan: Before you have a discussion with your insurance provider, make sure you understand the specifics of your policy, what it covers, and what it doesn&#;t.

• Doctor&#;s support: Have a detailed discussion with your healthcare provider about why they believe CLT is necessary for your condition. They can provide a written explanation or letter of medical necessity that you can present to your insurance company.

• Research: Gather any evidence-based research that supports the use of CLT for your specific condition. This can further support your claim.

• Persistence: Insurance matters can sometimes require perseverance. Don't be disheartened if your initial request is denied. There's often an appeal process that you can pursue.

• Seek professional advice: Consider consulting with a patient advocate or insurance expert. They can offer guidance based on their experience with similar cases.

Remember, all insurance plans differ, so always verify with your insurance provider and healthcare professionals to understand your best options.

Conclusion

Navigating the world of healthcare and insurance can be complex, particularly when it comes to treatments like Cold Laser Therapy. When it comes to coverage, most insurance providers, including Medicare, generally do not cover CLT. The cost of the therapy can be an out-of-pocket expense unless specific conditions are met, such as being part of a Medicare-approved clinical trial or being covered under a comprehensive private insurance plan.

Despite the complexity, remember that your health and well-being are worth the effort. Always consult with your healthcare providers and insurance representatives for personalized advice, as they can help guide you through this intricate landscape.

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post helpful, we kindly ask you to share it with others who might benefit as well.

Remember, healthcare is not one-size-fits-all. Stay informed, be proactive, and take the best possible care of your health. If you have any questions about your Medicare, please give us a call at

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