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Insurance Guide

Many of the Emerson WorldWide pain relief products are eligible for insurance coverage when prescribed by a medical professional. If you have been injured on the job, or if you have an injury that requires a pain management product, in most cases, insurance companies will pay 80%-100% of costs of chronic pain reliever units. It is the Buyer's responsibility to file insurance claims. We do not have a listing of all the insurance codes for all the products, but we do have a few.

Examples:
1. The Pain-X-2000 Infared Therapy products, the first Polychromatic infrared diode therapy devices that have this FDA clearance, are patented as a Polychromatic (Multi Wavelength) body irradiator, and are billiable under code E1399, AMA CPT Code 97026, Medicare Purchase E0221-NU.
2. The Terraquant LASER -Unfortunately there is still no CPT code for laser.!
The other options is to go with a very similar code, which falls into the right category.
For the Terraquant, it is the infared category, since laser is infrared.

DME # E0221 - INFRARED HEATING PAD SYSTEM
It may work or may not, it will depend on the state and insurance company.
We have seen several get approved very recently, so I hope this will be approved as well.
If they need it, the FDA clearance 510k # K080102.

Following are some more codes that may or may not work:
CPT Codes - Current Procedural Terminology

Based on an accepted diagnosis code and appropriate modifier (as discussed above), the billing is then made under a published procedure code. Cold laser or Low Level Laser Therapy (LLLT) does not have its own dedicated CPT code yet, so it is currently being billed and reimbursed under a variety of published CPT codes.

97039* Physical Medicine and Rehabilitation - Constant Attendance Unlisted Modality; 15 minutes

The problem with the code is that, being unspecified, it is occasionally rejected by some insurance carriers or hand audited. Make sure you have a one-page description of the treatment and the therapy (attached) if a carrier wants more information. You might try submitting this code as: 97039: Attended FDA Cleared Infrared Laser Therapy.

97140 Manual Therapy Techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes.

Procedure/outcome/result is the key here, not the way in which the procedure/outcome/result is obtained/performed. When using CPT Code 97140 you are billing for what you are doing or accomplishing not the technique used to bring about the desired effect/result. No documentation is needed when submitting claims using 97140 unless the carrier requires it for that specific patient or case. When documentation is required, document what area was treated and what was accomplished (release, drainage, reduction in inflammation, etc...), but specific techniques (i.e., laser, ultrasound, etc...) are not required in this documentation.

97026 Infrared. While this code refers to an infrared modality, its origin is with an infrared heat lamp. This device is a non-thermal device, and as such is does not produce heat. Therefore, it is NOT an infrared heating device. Use of this code may be inappropriate and it is likely to garner a very low value. To improve reimbursement, try listing it as an attended modality or adding a –22 or an “unusual procedural services.” Three ways this code can be used: 97026: Attended photonic stimulation // 97026: Attended infrared light therapy // 97026-22: Attended infrared therapy

97032 Attended Electrical Stimulation.

This is a code that many practitioners modify for laser and LED therapy. It can be billed in a number of ways and is reimbursed quite well. Although the CPT code will stay the same, 97032, the description will be changed to accurately reflect the service performed. Some ways that we have seen this code utilized by physicians and therapists: 97032: Attended Electrical-Photonic Stimulation // 97032: Attended Electrotherapy/IR // 97032: FDA Cleared Laser Photonic Stimulation.

97139* Physical Medicine and Rehabilitation - Constant Attendance Procedure, 15 minute unit.

This code is for a therapeutic procedure meaning that the doctor must have one-on-one contact with the patient. The strength of the code is that it tells the insurance carrier that the doctor is spending direct treatment time with the patient. The weakness of the code is that an unlisted procedure is more likely to be closely inspected by an insurance carrier. Coding might look like: 97139: FDA Cleared Laser Photonic Stimulation: Constant attendance.

97112 Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities.

97799* Physical Medicine & Rehabilitation - Unlisted Service or Procedure (negotiated fee, requires documentation)

97801 Acupuncture Modality

* Codes ending in a “9” require an explanatory notation. Typically, these codes have been submitted referring to the FDA cleared device and therapy; for example: “97039 – FDA Cleared Laser Therapy”. Also, you may be asked to submit additional documentation explaining the therapy; for that purpose, a one-page explanation accompanies this memo.

Steps to take:

1. Call your Insurance Carrier to determine if they will cover the product.

2. Most insurance carriers require a prescription and letter of medical necessity.To obtain maximum benefits, the letter must explain and document the long-term benefits of the product treatment for you versus prescribed medication. It may also detail cost savings the product will provide to your carrier, versus other remedies. Upon your request, we will provide product information that you can give to your doctor that can help with language and documentation. Providing accurate information will help you with your claim.

Sample Letter of Medical Necessity   

                            
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