Cash Reimbursement and a New Profit Center
Reimbursement Update for Class IV High Power Laser Therapy (HPLT)
Billing and reimbursement issues are an integral part of any practice. In order to maintain a thriving practice, receiving the appropriate reimbursement is mandatory. Unfortunately the medical profession (with declining reimbursements) is undergoing numerous changes for the detriment of today's clinician, many of which are dramatically reducing practice cash flow and ultimately physician revenue. With patients now demanding better care and billions of dollars being spent on over the counter and alternative therapies, isn't it time you captured a portion of this rapidly expanding cash driven market?
Avicenna's Class IV High Powered Therapeutic Laser now offers doctors a painless, non-surgical treatment solution for even the toughest musculoskeletal, orthopedic, and neurological maladies. Conditions such as herniated discs, spinal stenosis, sciatica, failed back surgery syndrome, severe arthritis, carpal tunnel syndrome and even neuropathy all respond quite well to our device. Soft tissue injury recovery is also dramatically accelerated. Average time for resolution of the aforementioned conditions range from 5-10 patient visits with each session lasting from 10-25 minutes depending on treatment location.
Implementing an Avicenna turnkey high power therapeutic laser center of excellence is the perfect vehicle for improving the quality of your patient's care, as well as providing you with a significant new source of passive revenue. Doctor's implementing Avicenna's technology and proprietary protocols are generously getting reimbursed in either a cash or traditional insurance reimbursement modeled practice. Either way, your success is guaranteed.
High Power Laser Therapy (HPLT) Delivers 100% Private Pay - Cash Reimbursement
Because there is not a unique reimbursement code for HPLT the following billing models are recommended. To date over 75% of Avicenna purchasers implement a cash only – private pay model. It has been well demonstrated in the majority of our users offices that patients will gladly pay out of pocket for results. Under this scenario reimbursement is always 100% and no additional staffing is required to implement collections. Cash paying patients also generate cash paying referrals. Using this model many patients will opt for longer treatment times at a greater frequency, especially when they are counseled that results will come quicker than what is allowable under traditional insurance based protocols. Average per minute charge is $5-8 with the majority of patients opting for treatment durations of 20-30 minutes because of the ability to achieve a quicker positive outcome.
Proprietary treatment protocols along with excellent results do allow doctors seeking insurance reimbursement to collect on an average $50-75 billing under CPT code 97039 or 97799 per "unit" of time. Avicenna recommends providing meticulous notes on all patients along with fully documenting progress using objective outcome measurements.
Insurance Reimbursement (MD – DO)
Due to the fact that precision placement of the laser beam is important, we recommend that the physician exam and mark the patient with a surgical marker at the beginning of each treatment session. The physician should bill an established patient E&M service (99212). The actual laser treatment should then be performed by a licensed therapist (ie:RPT) who can sign the HCFA 1500 claim form. The codes for laser therapy treatment are 97039-constant attended unlisted modality or 97799- unlisted physical medicine/ rehabilitation service or procedure along with full documentation as previously discussed. Those physicians using the Cryo-6 cold air system can bill under 97010.
FDA Clearance – CPT Codes
2002 marked the first year that the FDA granted clearance for the marketing of therapeutic lasers in the US. Since that time, the AMA has not dedicated a specific CPT code for the reimbursement of laser therapy. Once therapeutic outcome studies are published in recognized peer reviewed journals, this information can be used to petition the AMA’s CPT advisory committee for a new Physical Medicine and Rehabilitation code.
Avicenna Laser Technology has taken an aggressive stand in promoting evidenced based treatment protocols to validate the efficacy of Class IV laser therapy. Taking a passive, “wait and see” approach would inevitably lead to further delays in obtaining CPT coding due to the poor clinical outcomes generated by “Low-level”, Class III laser systems.
Academia Embracing Avicenna's Technology
The world of therapeutic laser technology offers exciting opportunities. Therapy with more powerful lasers appears to be an extremely promising way to further development of this technology in pain management and other conditions. As with the new Avicenna Class IV Laser device, partnerships are being forged with leading Universities and clinics to provide outcomes data for today’s evidence-based healthcare system.
Regarding the efficacy and claims made by U.S. Class III Low-Level Laser manufacturers, we would like note a quote from one of the world’s foremost experts in laser therapy and author of the fields most highly regarded text on the subject. Jan Tun’er states, “But with the type of promotion outlined above (regarding to the Erchonia Laser), I can see two alternatives for myself: to speak up and start a conflict within the laser community, maybe discrediting the therapy itself in the eyes of the general public or to keep quiet and let US practitioners pay a lot of money for a very low-powered laser, leaving us with dissatisfied customers and discredit from those who are supposed to use laser therapy in medicine.1” Caveat emptor. 1. Tun'er J, Hode L. Laser Therapy Clinical Practice and Scientific Background. Prima Books AB. Grangesberg, Sweden, 2002.