Billing for Low-Level Laser Therapy

Q: I am thinking of purchasing a "low-level laser" to treat my patients. Is there a code I can use for this service, and is it being reimbursed?

A: Low-level laser therapy has become popular within the physical-medicine community for use in soft-tissue and wound injuries. There has been considerable positive empirical value noted from numerous sources. Low-level laser devices have had FDA approval (market clearance) since 2002.

Low-level laser light is compressed light of a wavelength from the cold, red part of the spectrum of electromagnetic radiation. It's different from natural light in that it's one precise color, coherent (it travels in a straight line), monochromatic (a single wavelength) and polarized (it concentrates its beam in a defined location or spot). These properties allow laser light to penetrate the surface of the skin with no heating effect, no damage to the skin and no known side effects. Laser light directs biostimulative light energy to the body's cells, which the cells then convert into chemical energy to promote natural healing and pain relief.

Most states' chiropractic scope of practice allows the use of physical-medicine services including "light" or "heat." Therefore, it's a service a doctor of chiropractic may provide under their licensure. It's the individual provider's responsibility to ensure their state regulations allow the use of this device.

The question you asked is about coding the service and if insurance will reimburse for its use. At this time, there is no CPT code that specifically describes "low-level laser." The only CPT coding choice would be 97039 (unlisted modality), which requires an explanation of the service provided and if the service is attended or unattended. The explanation of the service can now be done in block 24 of the CMS1500, in the pink-shaded region above the specific line of billing for 97039.

Under the HCPCS coding system, there is a code S8948 that describes application of modality (requiring constant attendance) to one or more areas with low-level laser, each 15 minutes. This code can be used, but is not recognized by many carriers. It's worth attempting, as this code describes the service specifically and requires no added explanation with the billing. If it's not accepted, then the default code would be the 97039, with the aforementioned addendums to the billing.

Reimbursement is spotty among insurance payers for various reasons. One reason is that the service is considered experimental. Bear in mind that FDA approval generally does not indicate efficacy of use, but safety. For example, Aetna's official policy with reference to laser is: "Aetna considers cold-laser therapy 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." Blue Cross and CIGNA have similar policies with reference to laser treatment.

Plans with this type of policy will not pay for the service, but this does not mean the patient is not responsible for payment. As long as you are not a member provider of the insurance plan, the patient is responsible for payment. Offices that utilize laser treatment should clearly indicate to patients who receive laser therapy that it might not be covered by their insurance and that they are responsible for payment. This notification is best done in writing to ensure the patient does not "misremember" and later want to renege on payment. However, if you are a member of the insurance plan, you must clarify with the carrier that services they do not cover may be billed directly to the patient. Some plans will require that member providers cannot collect for services they deem not medically necessary. In that circumstance, the laser would be a "free" or added-value service with no direct reimbursement.

Yes, laser treatment does empirically appear to offer benefits, but for insurance to embrace the service I will quote Cigna Healthcare: "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."

My hope is that manufacturers are taking this statement and setting up well-designed, double-blind clinical trials and allowing the results to speak for themselves. In the current times of evidence-based care, we can no longer rely on how we have done things in the past. We must move ahead and not only believe in what we do, but also prove it in a true clinical setting. This can be costly, but if manufacturers expect us to pay tens of thousands of dollars, we cannot do so and then get no reimbursement. The good news is the service is gaining popularity and I expect we will see some controlled studies in the future. If we do not, this service likely is not all it was stated to be. Evidence-based care demands that we put up or shut up.