Will the New Low Level Laser Therapy Code Solve Your Billing Issues?

July 8th, 2019 - Wyn Staheli, Director of Research

Categories: CPT^® Coding HCPCS Coding Diagnosis Coding Chiropractic Physical Medicine|Physical Therapy

Low level laser therapy (LLLT), also known as cold laser therapy, is a form of phototherapy which uses a device that produces laser beam wavelengths, typically between 600 and 1000 nm and watts from 5–500 milliwatts (mW). It is often used to treat the following:

Inflammatory conditions (e.g., Rheumatoid Arthritis, Carpal Tunnel Syndrome, Bursitis)
Pain management (e.g., Fibromyalgia, Bursitis, Myofascial Pain, Fasciitis)
Connective tissue injury (e.g., Tendonitis, Tendon Ruptures, Sprains)
Joint or muscle injury (e.g., Dislocations, Osteoarthritis, Muscle ruptures)

Up until now, there has been no CPT code to describe LLLT. Providers had to use unlisted codes such as 97039 or 97139. Some payers allowed the use of S8948 “Application of a modality (requiring constant provider attendance) to one or more areas; low-level laser; each 15 minutes”. As of July 1, 2019, there’s another code option:

0552T Low-level laser therapy, dynamic photonic and dynamic thermokinetic energies, provided by a physician or other qualified health care professional

BEFORE getting too excited and start billing, using this new code, look carefully at the following key words in its description: dynamic photonic and dynamic thermokinetic energies. Your device must meet both criteria. We do know that the Willow Curve brand meets the criteria. If you are unsure, be sure to check with your manufacturer.

No matter which codes are being used, historically many payers have not paid for these services. As of the date of this article, many payer policies still state that the use of LLLT is considered investigational and therefore not medically necessary. CMS’ 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 the 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.”

Perhaps the implementation of this new code will help change the status quo. There is one payer policy that includes this new code, but the policy still states that it is considered investigational. The policy also states that “This Medical Policy will be reviewed regularly and be updated as scientific and medical literature becomes available.”

It should be noted that code 0552T has been assigned category “M” by Medicare which is defined as “Items and Services Not Billable to the MAC. Not paid under OPPS.” Therefore, Medicare won’t be paying for it and it appears that others may also be following Medicare. Therefore, the best plan would be to use the most applicable code as allowed by the payer and which meets the code definitions. Just know that you may likely have a denial and be sure the patient understands that it will likely be an out-of-pocket expense.

Note: We do NOT recommend using code 97026 for LLLT which states that it is for “infrared” treatment. While some may argue that LLLT uses an infrared beam, we feel that this code should NOT be used to report LLLT for the following reasons.

CPT Assistant, February 2010 states that you should NOT use 97026 for LLLT “Because laser is a totally different mechanism of light energy and is basically a non-heat generating modality…” At the time of this article, there was not a CPT Assistant addressing the new code 0052T. We will need to watch and see if further guidance is provided by the AMA.

Code 97026 is a supervised modality whereas LLLT typically requires constant attendance.

References:

###

Questions, comments?

If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.

Latest articles: (any category)

COVID Vaccine Coding Changes as of November 1, 2023
October 26th, 2023 - Wyn Staheli

COVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.

Medicare Guidance Changes for E/M Services
October 11th, 2023 - Wyn Staheli

2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....

Can We Score Interpretation of an EKG Towards E/M Medical Decision Making?
October 10th, 2023 - Aimee Wilcox

When EKGs are performed in the facility setting or even in the physician's office, what are the requirements for reporting the service and who gets credit for scoring data points for Evaluation and Management (E/M) medical decision making (MDM)? Let's take a look at a few coding scenarios related to EKG services to get a better understanding of why this can be problematic.

Accurately Reporting Signs and Symptoms with ICD-10-CM Codes
October 5th, 2023 - Aimee Wilcox

Coders often find themselves unsure of when to report a sign or symptom code documented in the medical record. Some coders find their organization has an EHR that requires a working diagnosis, which is usually a sign or symptom, be entered to order a test or diagnostic study or image. Understanding the guidelines surrounding when signs and symptoms should be reported is the first step in correct coding so let's take a look at some scenarios.

The 2024 ICD-10-CM Updates Include New Codes for Reporting Metabolic Disorders and Insulin Resistance
September 19th, 2023 - Aimee Wilcox

Diabetes is a chronic disease that just seems to consistently be increasing instead of improving resulting in a constant endeavor by medical researchers to identify causal effects and possible treatments. One underlying or precipitating condition that scientists have identified as a precipitating factor in the development of diabetes is insulin resistance, which is a known metabolic disorder. As data becomes available through claims reporting, additional code options become possible with ICD-10-CM.

Documenting and Reporting Postoperative Visits
September 12th, 2023 - Aimee Wilcox

Sometimes we receive questions regarding documentation requirements for specific codes or coding requirements and we respond with information and resources to support our answers. The following question was recently submitted: Are providers required to report postoperative services on claims using 99024, especially if there is no payment for that service? What documentation is required if you are reporting an unrelated Evaluation and Management (E/M) service by the same physician during the postoperative period?

Understanding Gastroesophageal Reflux Disease and ICD-10-CM Coding
August 22nd, 2023 - Aimee Wilcox

Gastroesophageal reflux disease or GERD for short, is a disease that impacts millions of Americans on a weekly basis. Symptoms are uncomfortable, as are some of the tests used to diagnose it, but understanding the disease, tests, and treatments helps us better understand how to code the disease using ICD-10-CM codes.