Health Insurance Information

Cold Laser or Low-Level Laser Therapy (LLTT) is used to treat a variety of medical conditions. The following list of diagnoses may be appropriate for cold laser therapy. Please consult your doctor or the ICD-10-CM TABULAR LIST of DISEASES and INJURIES available on cdc.gov.

Suggested Clinical Uses for Cold Laser Therapy:

INFLAMMATORY CONDITIONS

  • Rheumatoid Arthritis
  • Epicondylitis
  • Carpal Tunnel Syndrome
  • Bursitis
  • Plantar Fasciitis

Primary Diagnosis

  1. Pain
  2. Restricted range of movement/stiffness
  3. Edema
  4. Effusion
  5. Paresthesia
  6. Inflammation
  7. Adicular Pain
  8. Muscle Spasms
  9. Myofasciitis

PAIN MANAGEMENT

  • Fibromyalgia
  • Bursitis
  • Lower back pain
  • Myofascial Pain
  • Fasciitis
  • Neck/Cervical pain

Primary Diagnosis

  1. Pain
  2. Restricted range of motion/stiffness
  3. Inflammation
  4. Effusion
  5. Edema
  6. Muscle spasms
  7. Mysofasciitis

CONNECTIVE TISSUE INJURY

  • Tendonitis
  • Tendon Ruptures
  • Sprains
  • Strains

Primary Diagnosis

  1. Pain
  2. Inflammation
  3. Restricted range of motion/stiffness
  4. Effusion
  5. Edema
  6. Muscle spasms
  7. Myofasciitis
  8. Radicular pain

JOINT INJURY

Temporomandibular ™ disorders

  • Ligament injury
  • Dislocations
  • Osteoarthritis

Primary Diagnosis

  1. Joint pain
  2. Inflammation
  3. Restricted range of motion/stiffness
  4. Joint effusion
  5. Edema

MUSCLE INJURY

  • Muscle bruises/contusions
  • Muscle contractures
  • Muscle ruptures
  • Myositis

Primary Diagnosis

  1. Muscle Pain
  2. Inflammation
  3. Restricted range of motion/stiffness
  4. Muscle spasms
  5. Edema
  6. Myofasciitis

NEUROLOGICAL INJURY

  • Ruptured disc
  • Prolapsed disc
  • Crush injuries
  • Neuritis

Primary Diagnosis

  1. Radicular pain
  2. Myofasciitis
  3. Decreased range of motion/stiffness
  4. Inflammation
  5. Muscle spasms
  6. Paresthesia
  7. Edema
  8. Effusion

SKIN INJURIES AND CONDITIONS

  • Burns
  • Skin ulcers
  • Skin grafts
  • Surgical incisions

Primary Diagnosis

  1. Joint pain
  2. Inflammation
  3. Restricted range of motion/stiffness
  4. Edema

Current Procedural Terminology:
Current Procedural Terminology, or CPT, codes-maintained by the American Medical Association-are “the most widely accepted medical nomenclature used to report medical procedures and services under public and private health insurance programs. After a diagnosis is made and an appropriate code is assigned (see above), insurance billing is made according to the particular CPT code.

Because cold lasers or LLLT’s do not have its own CPT codes, the following codes are being used for reimbursement:

97039 Physical Medicine and Rehabilitation; constant attendance unlisted modality; 15 minutes

97026 Infrared

This code refers to an infrared heat lamp, but cold lasers are not an infrared heating device. Consequently, reimbursement can be low. To improve reimbursement, list it as an attended modality or by adding a -22. Here are examples:

97026: Attended photonic simulation

97026: Attended infrared light therapy

97026–22: Attended infrared therapy

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.

97112 Neuromuscular Re-Education and Gait Training (movement, balance, coordination, kinesthetic sense, posture, and proprioception for sitting or standing activities); constant attended; each 15 minutes

97799 Physical Medicine and Rehabilitation – Unlisted Service or Procedure (requires documentation, fees negotiated)

97901 Acupuncture Modality

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