Billing for Laser Therapy
There’s no question that low-level laser therapy can help boost your practice by providing an added dimension that no other modality can do. And there’s also no question that you can bill for laser therapy—but there are issues that can make the billing process difficult.
The primary concern is that laser therapy doesn’t yet have an assigned billing code that’s accepted by the insurance industry. However, it’s important to remember that many modalities did not have assigned codes—and didn’t for many years—until insurance companies decided to accept them (HIV or Lyme disease treatment are two that come immediately to mind).
When to Bill
Billing is just one way to ensure low-level laser therapy is a profit center for your practice (more on that later). If you’re interested in exploring billing, make sure to first examine your case locally and statewide. Are you in a state where Medicare easily reimburses, or is there excellent workers compensation insurance or personal injury insurance in your area? Nationally, it is getting more difficult to be reimbursed, but if your particular region or state offers favorable insurance rates, it can be very profitable to bill.
When billing, the key point is to resist temptation to bill in a gray area as fines or even jail time are a possibility for improper billing. For laser therapy, practitioners can feel comfortable billing to the following codes:
- 97039, Physical Medicine and Rehabilitation: This is the primary code I would recommend for billing for low-level laser therapy. Specify a 10- or 15-minute treatment, and also provide the explanatory notation of “FDA cleared laser therapy.”
- 97139, Physical Medicine and Rehabilitation: This is also a good code to use; however, note that this particular code specifies a “procedure,” whereas 97039 specifies a “modality,” which is a better descriptor. When using this code, make sure to provide the explanatory notation of “FDA cleared laser therapy” and a one-page description of the therapy.
- 97026, Infrared Modality: This code describes laser therapy well. However, many insurance companies consider this code appropriate for infrared heat lamps. Reimbursement is low, but it is a legitimate code.
- 97140, Manual Therapy Techniques: Use this code if you are using laser therapy for massage. In this case, you must be using a laser fitted with a head designed to be a massage tool; you are not simply applying the laser in one place but are using it for massage; and your patient can experience and perceive that you are providing a massage service.
If You Choose Not to Bill
The challenge with billing is that sometimes you will only be reimbursed for a portion of what you bill—while you are paying for full-time or contracting for part-time competent billing staff.
In response many practitioners are now choosing to offer low-level laser therapy on a cash-only basis. This can be another very effective way of bringing profit to your practice, even if your rates are low.
Because many patients do find that laser is helpful, yet are not able or willing to come in and pay the full fee, another option is to offer low-level laser therapy for rent at your practice. You can purchase a relatively inexpensive laser ($1,000 to $3000) and rent it to patients at a flat fee, say $50/week. You will likely find that demand is high—so much so that most patients are unwilling to give the tool back at the end of the week!—and in a short period of time, you can recoup your costs and establish another profit center.
Low-level laser therapy is fast becoming a widely accepted modality as patients recognize and demand its benefits. No matter how you charge, it’s clear that laser therapy is an essential part of today’s successful practice.