RE: Infrared Therapy-- cannot use 97026

[Guest guest]

Medicare recently sent out the following advisory regarding Anodyne and MIRE:

CMS has established guidelines for infrared treatments. Heat treatments of this

type do not ordinarily require the skills of a qualified physical therapist.

However the skills of a physical therapist might be required in such treatments

where the patient’s condition is complicated by circulatory deficiency, areas of

desensitization, open wounds or other complications. Because ATS does not

produce heat, this modality cannot be considered as infrared heat treatments.

After careful review of the published literature on ATS, Palmetto GBA has

determined that the ATS device has not been shown to be a safe, specific or

effective treatment of any condition, and therefore is not reasonable and

necessary, whether provided in the home or as a professional service.

Furthermore, ATS does not qualify as a true infrared heating modality and must

not be submitted under CPT code 97026. The provider must not submit ATS as CPT

code 97039 since ATS does not require direct one-on-one contact. When a denial

is needed, the professional service must be submitted as CPT code 97799. HCPCS

code E0221 for the device will be denied as not medically necessary.

Here is the link:

http://www.palmettogba.com/palmetto/providers.nsf/(Docs)/9AC71FDA6E5514228525709\

70068C925?OpenDocument

Regards, Robin Roach

Cornwell wrote:

I believe you are referring to the laser component of

the Solaris unit. My understanding is that you need

to use the Infrared CPT code 97026 for that treatment.

We have also been advised to use the Infrared CPT

code for MIRE treatment. There are really no accurate

codes for laser or MIRE. One could use the code

" unlisted modality " 97039, but most billing systems do

not allow you to put in the description for type and

constant attendance time - therefore you will not get

reimbursed. Of course you only get $4 - $5 for the

infrared code.\

Pat Cornwell

Palos Community Hospital

--- " Kaluzny, R. "

wrote:

> I am referring to Infrared. Tom

>

> Infrared Therapy

>

> We have been using the Dynatron Solaris IR and have

> been bundling the

> treatment with other modalities. I would like to

> start actually documenting

> the use of the IR. Would anyone share what code

> they are using and what

> they are charging for the treatment? I can find IR

> in the CPT codes, but it

> is for IR unattended. Thanks for your help.

>

> Tom Kaluzny PT

>

> Rehabilitation Services Manager

> Mount Carmel Hospital

> 982 E. Columbia

> Colville, Washington 99114

> Office:

> Fax:

> Cell:

>

> T

>

>

>

>

>

> Looking to start and own 100% of your own Practice?

>

> Visit www.InHomeRehab.com.

> PTManager encourages participation in your

> professional association. Join

> and participate now!

>

[Guest guest]

Medicare recently sent out the following advisory regarding Anodyne and MIRE:

CMS has established guidelines for infrared treatments. Heat treatments of this

type do not ordinarily require the skills of a qualified physical therapist.

However the skills of a physical therapist might be required in such treatments

where the patient’s condition is complicated by circulatory deficiency, areas of

desensitization, open wounds or other complications. Because ATS does not

produce heat, this modality cannot be considered as infrared heat treatments.

After careful review of the published literature on ATS, Palmetto GBA has

determined that the ATS device has not been shown to be a safe, specific or

effective treatment of any condition, and therefore is not reasonable and

necessary, whether provided in the home or as a professional service.

Furthermore, ATS does not qualify as a true infrared heating modality and must

not be submitted under CPT code 97026. The provider must not submit ATS as CPT

code 97039 since ATS does not require direct one-on-one contact. When a denial

is needed, the professional service must be submitted as CPT code 97799. HCPCS

code E0221 for the device will be denied as not medically necessary.

Here is the link:

http://www.palmettogba.com/palmetto/providers.nsf/(Docs)/9AC71FDA6E5514228525709\

70068C925?OpenDocument

Regards, Robin Roach

Cornwell wrote:

I believe you are referring to the laser component of

the Solaris unit. My understanding is that you need

to use the Infrared CPT code 97026 for that treatment.

We have also been advised to use the Infrared CPT

code for MIRE treatment. There are really no accurate

codes for laser or MIRE. One could use the code

" unlisted modality " 97039, but most billing systems do

not allow you to put in the description for type and

constant attendance time - therefore you will not get

reimbursed. Of course you only get $4 - $5 for the

infrared code.\

Pat Cornwell

Palos Community Hospital

--- " Kaluzny, R. "

wrote:

> I am referring to Infrared. Tom

>

> Infrared Therapy

>

> We have been using the Dynatron Solaris IR and have

> been bundling the

> treatment with other modalities. I would like to

> start actually documenting

> the use of the IR. Would anyone share what code

> they are using and what

> they are charging for the treatment? I can find IR

> in the CPT codes, but it

> is for IR unattended. Thanks for your help.

>

> Tom Kaluzny PT

>

> Rehabilitation Services Manager

> Mount Carmel Hospital

> 982 E. Columbia

> Colville, Washington 99114

> Office:

> Fax:

> Cell:

>

> T

>

>

>

>

>

> Looking to start and own 100% of your own Practice?

>

> Visit www.InHomeRehab.com.

> PTManager encourages participation in your

> professional association. Join

> and participate now!

>

[Guest guest]

Medicare recently sent out the following advisory regarding Anodyne and MIRE:

CMS has established guidelines for infrared treatments. Heat treatments of this

type do not ordinarily require the skills of a qualified physical therapist.

However the skills of a physical therapist might be required in such treatments

where the patient’s condition is complicated by circulatory deficiency, areas of

desensitization, open wounds or other complications. Because ATS does not

produce heat, this modality cannot be considered as infrared heat treatments.

After careful review of the published literature on ATS, Palmetto GBA has

determined that the ATS device has not been shown to be a safe, specific or

effective treatment of any condition, and therefore is not reasonable and

necessary, whether provided in the home or as a professional service.

Furthermore, ATS does not qualify as a true infrared heating modality and must

not be submitted under CPT code 97026. The provider must not submit ATS as CPT

code 97039 since ATS does not require direct one-on-one contact. When a denial

is needed, the professional service must be submitted as CPT code 97799. HCPCS

code E0221 for the device will be denied as not medically necessary.

Here is the link:

http://www.palmettogba.com/palmetto/providers.nsf/(Docs)/9AC71FDA6E5514228525709\

70068C925?OpenDocument

Regards, Robin Roach

Cornwell wrote:

I believe you are referring to the laser component of

the Solaris unit. My understanding is that you need

to use the Infrared CPT code 97026 for that treatment.

We have also been advised to use the Infrared CPT

code for MIRE treatment. There are really no accurate

codes for laser or MIRE. One could use the code

" unlisted modality " 97039, but most billing systems do

not allow you to put in the description for type and

constant attendance time - therefore you will not get

reimbursed. Of course you only get $4 - $5 for the

infrared code.\

Pat Cornwell

Palos Community Hospital

--- " Kaluzny, R. "

wrote:

> I am referring to Infrared. Tom

>

> Infrared Therapy

>

> We have been using the Dynatron Solaris IR and have

> been bundling the

> treatment with other modalities. I would like to

> start actually documenting

> the use of the IR. Would anyone share what code

> they are using and what

> they are charging for the treatment? I can find IR

> in the CPT codes, but it

> is for IR unattended. Thanks for your help.

>

> Tom Kaluzny PT

>

> Rehabilitation Services Manager

> Mount Carmel Hospital

> 982 E. Columbia

> Colville, Washington 99114

> Office:

> Fax:

> Cell:

>

> T

>

>

>

>

>

> Looking to start and own 100% of your own Practice?

>

> Visit www.InHomeRehab.com.

> PTManager encourages participation in your

> professional association. Join

> and participate now!

>

[Guest guest]

Robin,

This is not Medicare. This is one Medicare contractor,

Palmetto GBA. There is a difference. Some Medicare

contractors do reimburse for anodyne under 97026 under

specific circumstances.

Rick Gawenda, PT

Director PM & R

Detroit Receiving Hospital

www.gawendaseminars.com

--- Robin Roach wrote:

> Medicare recently sent out the following advisory

> regarding Anodyne and MIRE:

>

> CMS has established guidelines for infrared

> treatments. Heat treatments of this type do not

> ordinarily require the skills of a qualified

> physical therapist. However the skills of a physical

> therapist might be required in such treatments where

> the patient’s condition is complicated by

> circulatory deficiency, areas of desensitization,

> open wounds or other complications. Because ATS does

> not produce heat, this modality cannot be considered

> as infrared heat treatments.

>

> After careful review of the published literature on

> ATS, Palmetto GBA has determined that the ATS device

> has not been shown to be a safe, specific or

> effective treatment of any condition, and therefore

> is not reasonable and necessary, whether provided in

> the home or as a professional service.

>

> Furthermore, ATS does not qualify as a true infrared

> heating modality and must not be submitted under CPT

> code 97026. The provider must not submit ATS as CPT

> code 97039 since ATS does not require direct

> one-on-one contact. When a denial is needed, the

> professional service must be submitted as CPT code

> 97799. HCPCS code E0221 for the device will be

> denied as not medically necessary.

>

> Here is the link:

>

http://www.palmettogba.com/palmetto/providers.nsf/(Docs)/9AC71FDA6E5514228525709\

70068C925?OpenDocument

>

> Regards, Robin Roach

>

> Cornwell wrote:

> I believe you are referring to the laser component

> of

> the Solaris unit. My understanding is that you need

> to use the Infrared CPT code 97026 for that

> treatment.

> We have also been advised to use the Infrared CPT

> code for MIRE treatment. There are really no

> accurate

> codes for laser or MIRE. One could use the code

> " unlisted modality " 97039, but most billing systems

> do

> not allow you to put in the description for type and

> constant attendance time - therefore you will not

> get

> reimbursed. Of course you only get $4 - $5 for the

> infrared code.\

> Pat Cornwell

> Palos Community Hospital

>

> --- " Kaluzny, R. "

> wrote:

>

> > I am referring to Infrared. Tom

> >

> > Infrared Therapy

> >

> > We have been using the Dynatron Solaris IR and

> have

> > been bundling the

> > treatment with other modalities. I would like to

> > start actually documenting

> > the use of the IR. Would anyone share what code

> > they are using and what

> > they are charging for the treatment? I can find IR

> > in the CPT codes, but it

> > is for IR unattended. Thanks for your help.

> >

> > Tom Kaluzny PT

> >

> > Rehabilitation Services Manager

> > Mount Carmel Hospital

> > 982 E. Columbia

> > Colville, Washington 99114

> > Office:

> > Fax:

> > Cell:

> >

> > T

> >

> >

> >

> >

> >

> > Looking to start and own 100% of your own

> Practice?

> >

> > Visit www.InHomeRehab.com.

> > PTManager encourages participation in your

> > professional association. Join

> > and participate now!

> >

[Guest guest]

Please be certain to check your FI or r, there are a number of

non-coverage decisions out there.

Pam Unger

Infrared Therapy

> >

> > We have been using the Dynatron Solaris IR and

> have

> > been bundling the

> > treatment with other modalities. I would like to

> > start actually documenting

> > the use of the IR. Would anyone share what code

> > they are using and what

> > they are charging for the treatment? I can find IR

> > in the CPT codes, but it

> > is for IR unattended. Thanks for your help.

> >

> > Tom Kaluzny PT

> >

> > Rehabilitation Services Manager

> > Mount Carmel Hospital

> > 982 E. Columbia

> > Colville, Washington 99114

> > Office:

> > Fax:

> > Cell:

> >

> > T

> >

> >

> >

> >

> >

> > Looking to start and own 100% of your own

> Practice?

> >

> > Visit www.InHomeRehab.com.

> > PTManager encourages participation in your

> > professional association. Join

> > and participate now!

> >

[Guest guest]

Please be certain to check your FI or r, there are a number of

non-coverage decisions out there.

Pam Unger

Infrared Therapy

> >

> > We have been using the Dynatron Solaris IR and

> have

> > been bundling the

> > treatment with other modalities. I would like to

> > start actually documenting

> > the use of the IR. Would anyone share what code

> > they are using and what

> > they are charging for the treatment? I can find IR

> > in the CPT codes, but it

> > is for IR unattended. Thanks for your help.

> >

> > Tom Kaluzny PT

> >

> > Rehabilitation Services Manager

> > Mount Carmel Hospital

> > 982 E. Columbia

> > Colville, Washington 99114

> > Office:

> > Fax:

> > Cell:

> >

> > T

> >

> >

> >

> >

> >

> > Looking to start and own 100% of your own

> Practice?

> >

> > Visit www.InHomeRehab.com.

> > PTManager encourages participation in your

> > professional association. Join

> > and participate now!

> >

[Guest guest]

Please be certain to check your FI or r, there are a number of

non-coverage decisions out there.

Pam Unger

Infrared Therapy

> >

> > We have been using the Dynatron Solaris IR and

> have

> > been bundling the

> > treatment with other modalities. I would like to

> > start actually documenting

> > the use of the IR. Would anyone share what code

> > they are using and what

> > they are charging for the treatment? I can find IR

> > in the CPT codes, but it

> > is for IR unattended. Thanks for your help.

> >

> > Tom Kaluzny PT

> >

> > Rehabilitation Services Manager

> > Mount Carmel Hospital

> > 982 E. Columbia

> > Colville, Washington 99114

> > Office:

> > Fax:

> > Cell:

> >

> > T

> >

> >

> >

> >

> >

> > Looking to start and own 100% of your own

> Practice?

> >

> > Visit www.InHomeRehab.com.

> > PTManager encourages participation in your

> > professional association. Join

> > and participate now!

> >