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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. 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 E221-NU.
2. The LASER -Tens, LTU-1000 synergistically combines cold laser and TENS technologies for remarkable healing and pain relief. It is iInsurance reimbursable. Billing Codes: 97032, Application of a modality to one or more areas; electrical stimulation (manual), each 15 minutes.97112, Therapeutic procedure one or more areas each 15 minutes; neuromuscular reeducation of movement balance coordination kinesthetic sense posture and/or proprioception for sitting and/or standing activities.90901, Biofeedback training by any modality; and E1399, Cost of Unit Suggested code for purchase of unit as miscellaneous, Durable Medical Equipment.

The following are the most common codes used by practitioners of laser and LED therapy. We are not recommending any particular codes and cannot advise you on billing issues.

97026: Infrared
The beauty of this code is that it is for infrared light therapy. The problem with this code is that it is a code for a heat lamp. Thus, reimbursement can be quite low, although for some practitioners, Medicare reimburses it. To improve reimbursement, try listing it as an attended modality or adding a –22 or an “unusual procedural services.” Below are three ways these codes can be used:
97026: Attended photonic stimulation
97026: Attended infrared light therapy
97026-22: Attended infrared therapy

97039: Attended Modality, Unspecified
This is a code that is also being used to bill for attended modalities. Reimbursement is good because it is understood to take more time than an unattended code. 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 if a carrier wants more information. When the claim form goes out it will usually say something like:
97039: Attended infrared therapy or
97039: Attended laser 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. Below are some common ways that we have seen this code utilized by physicians and therapists:
97032: Attended Electrical-Photonic Stimulation or
97032: Attended Electrotherapy/IR

97139: Unlisted Therapeutic Procedure
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. Billing might look like:
97139: Photonic Stimulation: Constant attendance

97140: Manual Therapy Techniques
This code is for a manual therapy technique meaning that the practitioner must have one-on-one contact with the patient and perform manual therapy. The weakness of the code is that an unlisted procedure is more likely to be closely inspected by insurance carrier. In this case the practitioner must be using light therapy as an adjunct to some type of manual therapy.
Billing might look like:
97139: Manual Therapy + Infrared

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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