Laser Therapy FAQ 1 – Is Laser Therapy Covered By Insurance?
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 2016, a HCPCS II code (S8948) 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 S8948 code. For carriers that do not recognize HCPCS II codes, the appropriate ICD-10-CM Code for LLLT is 97039, “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 2007, The Laser Therapy Handbook, Prima Books AB, Grangesgerb, Sweden. 2. Fregapani, P, Matos de Oliveira, M, Neto, N, Pozza, D, Sobrinho, JB, Weber, J 2008, ‘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 1993, ‘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 1993, ‘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 2005, ‘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 2000, ‘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 2001, ‘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 1978, ‘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 1984, ‘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 2002, ‘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 2005, ‘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 1967, ‘Effect of laser on hair growth of mice’, Kiserl Orvostud, vol. 19, pp. 628-631.