Can your practice afford not to offer it?
By Mark Callanen, PT, DPT, OCS
Health care practitioners’ first question when assessing a modality is normally “Does it work?” Usually within minutes this transitions to “What is the CPT code?” and “Is it reimbursable?” If the answers to these questions are uninspiring, the conversation dries up quickly.
So how does laser therapy, commonly referred to as Low Level Laser Therapy (LLLT), stack up?
Does it work? Laser therapy, as of March 2018, has over 7,400 studies in PubMed related to how LLLT impacts musculoskeletal tissue. LLLT can be utilized as an adjunct to normal plans of care to help reduce pain and inflammation.1,2 Pain is reduced in various ways with laser therapy, which is more correctly referred to as photobiomodulation (PBM). Its mechanisms center around direct effects on afferent nerves as well as a variety of positive influences on the inflammatory cascade.3,4,5,6,7,8
Laser therapy has impacted professional and college training rooms for years. Lasers are currently being used by Major League Baseball organizations, multiple NFL and NBA teams, as well as over 100 Division I college training rooms. Traditionally it has been used in the chiropractic and veterinary markets, and in the past few years has begun to pick up momentum in the physical therapy space.
What is the CPT code? LLLT currently does not have a CPT code associated with it.
Is it reimbursable by third-party payers? LLLT has been reimbursed by specific insurers on occasion,* but there is no specific CPT code for it, which precludes it from being recognized by many insurers.
In 2004 a Healthcare Common Procedure Coding System (HCPCS) code (S8948) was developed for LLLT which can be utilized by insurers that recognize it. For carriers such as Medicare that do not recognize HCPCS codes, the appropriate CPT Code for LLLT is 97039, “Unlisted Modality.”
If you are like most practitioners, this is usually where your attention starts to wane. “If I can’t bill for it, why would I purchase a laser?”
The current economic environment with increasing overhead and decreasing reimbursement in the outpatient market has forced clinic owners to consider different cash options to generate revenue and differentiate their clinics from competitors, not only to be competitive, but to survive.
Higher power, Class 4 laser therapy positions itself well as a cash modality as it has the ability to reduce pain complaints in minutes.9,10,11 This unique ability to create quick analgesia for patients has many practices embracing laser therapy as an adjunctive cash option to enhance patients’ plans of care. The reduction of pain and inflammation will accelerate most plans of care, which holds value for both the patient and the clinician.
Given factors such as the opioid crisis in the United States and the large deductibles American families face for outpatient services, many patients are now actively looking for conservative, non-pharmaceutical solutions to quickly reduce their pain complaints. Class 4 laser is a value proposition many practices have historically overlooked due to the reimbursement obstacle, and in doing so have missed out on a significant opportunity.
How significant is the pain market? Pain-related diagnoses including low back pain, osteoarthritis, and general joint-related disorders account for over 57 percent of primary physician care visits annually.12 In 2010 the total financial cost of pain to the United States society was calculated to range from $560 to $635 billion, nearly 30 percent higher than the combined cost of cancer and diabetes.13
Treating pain is a complex topic that may require unique solutions. Starting a laser therapy program, or any cash program in a medical setting, requires training and coaching from experts in this area. That being said, having unique tools to treat the pain population is not only advisable, but if done well, could improve the financial health of a practice and the lives of many patients.
*TriWest/Tricare has reportedly reimbursed for LLLT in California and Maryland.
1Hode L & Turner J. The Laser Therapy Handbook. Grangesgerb, Sweden: Prima Books AB; 2007.
2Fregapani P, Matos de Oliveira M, Neto N, Pozza D, Sobrinho JB, Weber J. Analgesic action of laser therapy (LLLT) in an animal model. Med Oral Patol Oral Cir Bucal. 2008;13(10):E648-E652.
3Wakabayashi H. Effect of irradiation by semiconductor laser on responses evoked in trigeminal caudal neurons by tooth pulp stimulation. Lasers Surg Med. 1993;13(6):605-610.
4Kawatani M, Matsumoto I, Sato T, Takeshige C, Tsuchiya K. Diode laser irradiation selectively diminishes slow component of axonal volleys to dorsal roots from the saphenous nerve. Neurosci Lett. 1993;161(1):65-68.
5Benayahu D, Maltz L, Oron U, Stein A. Low-level laser irradiation promotes proliferation and differentiation of human osteoblasts in vitro, Photomedicine and Laser Surgery. 2005;23(2):161-166.
6Abiko Y, Sakurai Y, Yamaguchi M. Inhibitory effect of low-level laser irradiation on LPS-stimulated prostaglandin E2 production and cyclooxygenase-2 in human gingival fibroblasts. Eur J Oral Sci. 2000;108(1):29-34.
7Greco M, Marra E, Moro L, Passarella S, Perlino E, Petragallo VA, Vacca RA. Helium-neon laser irradiation of hepatocytes can trigger increase of the mitochondrial membrane potential and can stimulate c-fos expression in a Ca2+-dependent manner. Lasers Surg Med. 2001;29(5):433-441.
8Greguss P, Haina D, Mester A, Mester E, Nagylucskay S, Tisza S, Waidelich W. Effects of direct laser radiation on human lymphocytes. Arch Dermatol Res. 1978;263(3):241-245.
9Chow et al. Inhibitory effects of laser irradiation on peripheral mammalian nerves and relevance to analgesic effects: a systematic review. Photomedicine and Laser Surgery. 2011;X(X):1-17. Mary Ann Liebert, Inc.
10Holanda VM et al. The mechanistic basis for photobiomodulation therapy of neuropathic pain by near infrared laser light. Lasers Surg Med. 2017 Jul;49(5):516-524.
11Cotler et al. The use of low level laser therapy (LLLT) for musculoskeletal pain. MOJ Orthop Rheumatol. 2015;2(5):00068.
12Sauver JL et al. Why patients visit their doctors: assessing the most prevalent conditions in a defined American population. St. Mayo Clinic Proceedings, Volume 88, Issue 1, 56-67.
13Gaskin D. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research: Appendix C: The Economic Costs of Pain in the United States. Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Washington DC: National Academies Press (US); 2011.
Mark Callanen, PT, DPT, is the director of clinical development for LightForce Therapy Lasers. He has treated orthopedic patients for 18 years and has been board certified as an Orthopedic Clinical Specialist by the APTA since 2003. Mark graduated with his doctorate in physical therapy in 2007 from Marymount University. He can be reached at email@example.com.