Cold Laser and PIP reimbursement

[Guest guest]

I recently received a review from USAA that payment for Low Level Laser Therapy (LLLT)was being denied because a physician review they relied on from Auto Injury Solutions/Concentra opined that LLLT is considered experimental/investigational and should not be reimbursed. I have sent in an appeal letter stating that the OBCE has approved the use of LLLT, WSCC includes it in physiotherapy courses, and it is used in the campus clinic, and that other insurers have reimbursed for LLLT. I also referenced the recent study on LLLT in the Lancet from December 2009. Have others experienced this situation, and how can we better deal with this type of ignorance? What is the basis for a PIP insurer to consider a treatment investigational? I believe I have used the proper coding (97039) described as LLLT and correctly documented the

procedure and time in the chart notes. I disagree 100% with LLLT being considered investigational by a PIP insurer.

Please respond with questions/comments...

Brad Pfeiffer, DC

Bend, OR