Perhaps you have been using a new laser device, but are experiencing frustration over reimbursement. Sure, cash payments are nice, but may be a barrier for some patients. Is it possible for insurance carriers to pay for laser?
About one-third of chiropractic clinics currently use therapeutic lasers.1 Photobiomodulation (PBM) is the Medical Subject Headings2 (MeSh) term for laser therapy. It is hypothesized that red and near-infrared laser light can manage pain, reduce edema, and enhance tissue healing. It is thought that this action influences mitochondria to enhance cellular energy (ATP) output, among other effects.3-4
However, not much clinical research exists on this therapy. Even still, as conservative health care providers we should consider alternative pain management strategies, and when used properly, PBM is considered a safe treatment.
Most insurers and payors make coverage decisions based on guidelines and the best available scientific evidence. Some of these decisions made are to deny care. To overcome a denial, you must show the following:
A Case Example
Consider you are treating a patient who was involved in a motor-vehicle accident one month ago, and has persistent neck and radiating left arm pain. He is more than 50 years old, overweight and has tried aspirin, but this gives him gastric problems.
For the past three weeks, you have done manipulation, physiotherapy, stretching, massage, and have recommended exercise, but the patient says he is unable to do regular activity because he is out of shape. He reports that your therapies have helped, but only to a point, and you are concerned that his neck pain may become chronic.
The patient is apprehensive about trying injections and is asking you what else you can do to help. In this case, you may consider PBM since it has been shown to reduce inflammation and promote healing.
The patient's insurance carrier uses the Official Disability Guidelines (ODG),5 which considers laser therapy for neck pain "under study, with conflicting results,"6 and therefore will likely deny payment. In this case, you are going to have to show that this patient is the exception to the rule and could benefit from PBM.
Tips to Address Payment Denial
To get the care authorized and paid, you will need to provide why the guideline does not apply to this particular patient, and that reasonable alternatives are necessary and appropriate. Here are some helpful tips for this particular patient / case:
The guideline does not apply to this specific patient because of his comorbidities: He is 55, overweight and deconditioned, and cannot tolerate NSAIDs.
The patient has failed three weeks of conservative treatment and does not wish to undergo injections.
Better evidence exists: If the information is from an older guideline, newer and better-quality evidence is available. Additional new evidence that laser therapy might be an effective treatment for patients with neck pain includes:
Write a letter outlining the history, clinical findings and diagnosis. Include the relevant facts that support the patient being is an exception to the guidelines. Then support your proposed therapy (in this case, PBM) with copies of the relevant literature supporting your decision.
In your letter to the insurance carrier, propose a reasonable trial of care, say 6-12 visits, and use outcome tools such as the Neck Disability Index, numerical pain scale, and functional ability measures (e.g., lifting, work capacity, activities of daily living) to document improvement. These efforts will increase your likelihood of getting reimbursed for PBM therapy.
As part of our ongoing efforts to help translate research into practice, the Council on Chiropractic Guidelines and Practice Parameters (CCGPP), also known as the Clinical Compass, is working to translate scientific research into tools that the profession can use to improve clinical practice. There are no guarantees, but you can increase your chance of success.
For more information about other conditions that may be responsive to PBM and how to support the medical necessity of your proposed treatment plan, go to www.ccgpp.com.
References
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
