Edit Content
ircm White Logo 1
About Us

iRCM is an industry leader with innovative technology and an expert team. We are a complete Revenue Cycle Management solution that streamlines reimbursements and delivers remarkable results.

Contact Info

A Guide to CPT Code for Laser Therapy: Understanding Usage and Reimbursement

CPT Codes for Laser Therapy
Laser therapy involves the use of specific wavelengths of light to treat various medical conditions, ranging from pain management to skin disorders. This code serves as a standardized means for healthcare providers to document and bill for laser therapy procedures.
Understanding and correctly utilizing CPT codes such as 0552T is essential for healthcare providers, as it ensures accurate documentation of services rendered, facilitates communication between healthcare professionals, and enables proper reimbursement for the treatments provided.

Understanding CPT Codes

CPT (Current Procedural Terminology) codes serve as a standardized system for documenting medical procedures and services provided to patients. These codes, established and maintained by the American Medical Association (AMA), play a pivotal role in various aspects of healthcare delivery, including billing, reimbursement, and data analysis.
Organized systematically, CPT codes are categorized into three main sections: Category I for procedures and services, Category II for performance measurement, and Category III for emerging technologies, services, and procedures. The AMA regularly updates and revises these codes to reflect advancements in medical practice and technology, ensuring relevance and accuracy.

Laser Therapy in Healthcare

Laser therapy, represented by CPT code 97039, harnesses the power of concentrated light to stimulate biological processes within the body, promoting healing and pain relief. This non-invasive treatment modality operates on the principle of photobiomodulation, where specific wavelengths of light penetrate tissues to target cellular structures and trigger biochemical reactions.
Its therapeutic benefits range from reducing inflammation and accelerating tissue repair to alleviating pain and improving circulation. Laser therapy finds applications across various medical specialties, including dermatology for treating skin conditions like acne and psoriasis, orthopedics for managing musculoskeletal injuries such as tendonitis and arthritis, and pain management for addressing chronic pain syndromes like fibromyalgia and neuropathy.
This modality’s versatility and effectiveness have led to its growing acceptance within the healthcare community as an alternative or adjunctive therapy to conventional treatments.
  • Laser therapy operates on the principle of photobiomodulation, utilizing specific wavelengths of light to stimulate cellular processes and promote healing.
  • Its therapeutic benefits include reducing inflammation, accelerating tissue repair, alleviating pain, and improving circulation.
  • Laser therapy is utilized across diverse medical specialties, including dermatology, orthopedics, and pain management, demonstrating its wide-ranging applicability.
  • The non-invasive nature of laser therapy makes it an attractive treatment option, particularly for patients seeking alternatives to surgical interventions or pharmaceutical medications.

CPT Codes for Laser Therapy

When it comes to laser therapy procedures in chiropractic care, specific CPT codes are essential for accurate documentation and billing. Here’s a breakdown of the pertinent codes and their descriptions:
1. CPT Code 97026 - Infrared Light Therapy:
This code is utilized for infrared light therapy, primarily involving the application of heat lamps for superficial tissue heating. Reimbursement for this code tends to be low due to its association with older-style heat lamps.
CPT Code 97026 - Infrared Light Therapy
Some practitioners may receive reimbursement, particularly from Medicare, but it varies.
To potentially improve reimbursement, providers may consider listing it as an attended modality or appending a -22 modifier to denote “unusual procedural services.”
2. CPT Code 97032 - Attended Electronic Photonic Stimulation:
This code represents attended electronic photonic stimulation, typically administered over 15 minutes. It includes a time component, necessitating documentation of start and finish times in the patient’s chart.
CPT Code 97032 - Attended Electronic Photonic Stimulation
Treatment protocol and treated body areas should be briefly noted.
Billing should clearly indicate the nature of the treatment, such as “FDA cleared laser photonic stimulation.”
3. CPT Code 97039 - Unlisted Modality with Constant Attendance:
This code is designated for unlisted modalities requiring constant attendance during treatment. Its “unlisted” nature may lead to rejection or hand audits, necessitating thorough documentation.
CPT Code 97039 - Unlisted Modality with Constant Attendance
Including a one-page description of the services provided and a device description is recommended. Billing should specify the treatment, such as “Attended infrared therapy” or “Attended laser therapy.”
4. CPT Code 97112 - Neuromuscular Reeducation:
This code pertains to neuromuscular reeducation, commonly delivered over 15 minutes.
CPT Code 97112 - Neuromuscular Reeducation
Like other codes with a time component, start and finish times must be recorded in the patient’s chart. Treatment protocol and treated areas should be briefly outlined. Billing may indicate the inclusion of laser therapy if applicable.
5. CPT Code 97139 - Unlisted Therapeutic Procedure with Constant Attendance:
Designated for unlisted therapeutic procedures necessitating constant attendance.
CPT Code 97139 - Unlisted Therapeutic Procedure with Constant Attendance
Its “unlisted” nature may lead to rejection or hand audits, requiring comprehensive documentation. Including a one-page description of services and device description is advisable. Billing should clearly denote the use of FDA cleared laser therapy.
6. CPT Code 97799 - Unlisted Service or Procedure with FDA Cleared Laser Therapy:
This code covers unlisted services or procedures performed with FDA cleared laser therapy. Its general nature and “unlisted” status may result in rejection or hand audits, mandating thorough documentation.
CPT Code 97799 - Unlisted Service or Procedure with FDA Cleared Laser Therapy
Including a one-page description of services and device description is recommended.
Billing should clearly state the incorporation of FDA cleared laser therapy.

CPT Code for Low-Level Laser Therapy

Low-level laser therapy (LLLT), also known as cold laser therapy or photobiomodulation therapy, utilizes specific wavelengths of light to stimulate cellular function and promote healing. Unlike high-power lasers used for surgical procedures, LLLT operates at low levels that do not generate heat and are generally considered safe and non-invasive.
This therapy has been shown to have various therapeutic effects, including reducing inflammation, relieving pain, and accelerating tissue repair. In chiropractic care, LLLT is often utilized as a component of treatment for musculoskeletal conditions, such as joint pain, muscle strains, and tendonitis.
CPT code 0552T is specifically designated for low-level laser therapy sessions administered by a physician or other qualified healthcare professional. This code encompasses the use of dynamic photonic and dynamic thermokinetic energies, indicating the application of light energy to targeted areas for therapeutic purposes.
When billing for LLLT sessions, it’s crucial to accurately document the services provided, including the duration and intensity of the therapy session, the areas treated, and any specific patient responses or outcomes observed.
To code and bill for low-level laser therapy sessions effectively, follow these steps:
1.Identify the appropriate CPT code: Use code 0552T to represent low-level laser therapy sessions provided by a qualified healthcare professional.
2.Document the session details: Record the start and end times of the therapy session, the specific areas treated, and any relevant patient responses or improvements observed during or after the session.
3.Include a description of the therapy: Clearly state the nature of the therapy provided, emphasizing that it involves low-level laser therapy for therapeutic purposes.  

4.Submit the claim: When submitting the claim for reimbursement, ensure that all necessary documentation is included to support the billed services. This may include a treatment plan, progress notes, and any additional reports or assessments related to the therapy session.

CPT Code 97026: Infrared Light Therapy

CPT Code 97026 is designated for infrared light therapy, presenting practitioners with a versatile tool for addressing various conditions. However, its association with traditional heat lamps may result in lower reimbursement rates, posing a challenge for some providers.
Despite this, Medicare may offer reimbursement for certain practitioners, albeit varying. To enhance reimbursement possibilities, consider listing it as an attended modality or appending modifiers such as -22 to denote “unusual procedural services.”
  • 97026: Attended photonic stimulation
  • 97026: Attended infrared light therapy
  • 97026-22: Attended infrared therapy

CPT Code for Heat Therapy

Heat therapy, a common modality in physical therapy and rehabilitation, involves the application of heat to the body to alleviate pain, reduce muscle tension, and promote relaxation. This therapeutic technique enhances blood circulation, which can help accelerate the healing process for various musculoskeletal conditions.
In chiropractic care, heat therapy is often utilized as a complementary treatment to manual manipulation and exercise therapy, aiding in the management of conditions like muscle strains, joint stiffness, and chronic pain.
Several CPT codes are available to document and bill for heat therapy sessions accurately:
I. CPT Code 97010 - Hot or Cold Packs Therapy:
This code encompasses the application of hot or cold packs to the affected area, providing therapeutic relief. Reimbursement for this code is typically straightforward, as it directly reflects the use of hot or cold packs during treatment sessions.
II. CPT Code 97530 - Therapeutic Activities/Kinetic:
While not specifically designated for heat therapy, this code may be applicable when heat therapy is incorporated into a broader therapeutic activity session. It covers activities aimed at improving strength, endurance, range of motion, and flexibility, which may include heat therapy as part of the treatment regimen.
When coding and billing for heat therapy sessions, it’s essential to adhere to specific guidelines to ensure accurate reimbursement:

Documentation Requirements: Detailed documentation of the heat therapy session, including the duration of application, the temperature of the heat source, and the body areas treated, is essential for proper billing.

Modifiers: Depending on the circumstances of the treatment session, modifiers such as -59 (distinct procedural service) or -22 (unusual procedural services) may be appropriate to indicate additional complexity or unique circumstances.

Medical Necessity: Ensure that the provision of heat therapy is medically necessary and supported by the patient’s diagnosis and treatment plan to justify billing and reimbursement.

By adhering to these guidelines and utilizing the appropriate CPT codes, chiropractors can accurately document and bill for heat therapy sessions, facilitating proper reimbursement and effective management of patient care.

Does Insurance Cover Laser Therapy?

The coverage of laser therapy by insurance can vary significantly depending on several factors, including the type of insurance plan, the specific condition being treated, and the medical necessity of the therapy. While some insurance plans may offer coverage for certain types of laser therapy, others may consider it an elective or experimental procedure and, therefore, not covered.
It’s essential for patients to review their insurance policy details and consult with their healthcare provider to determine if laser therapy is covered under their plan and what out-of-pocket expenses they may incur. Additionally, obtaining prior authorization from the insurance company may be necessary to ensure coverage for laser therapy sessions.

Conclusion

Understanding the CPT codes for laser therapy and heat therapy is crucial for chiropractors and healthcare providers to accurately document, bill, and ensure proper reimbursement for these valuable treatment modalities. By familiarizing themselves with the specific CPT codes relevant to their practice and adhering to billing guidelines, practitioners can streamline administrative processes and optimize revenue cycles while providing quality patient care.
Navigating insurance coverage for laser therapy underscores the importance of patient education and proactive communication between providers and insurance companies to facilitate access to beneficial treatments.

Table of Contents

Recent Post

Get Customized Billing Quote