Eli's Rehab Report

Published on Mon Dec 24, 2012 PDF

CMS says no to reimbursing this modality.

You may be one of the many therapy clinics that love this modality as a method for treating patients with diabetic neuropathy -- but if you are one of these clinics, take note: CMS thinks otherwise.

After going without a finalized national coverage determination for quite some time, now infrared therapy is clearly a non-reimbursable treatment, Medicare says.

Clear Up Coverage Confusion

This national coverage determination might seem to contradict what you have heard in the past. For example, a lot of miscommunication has been floating around websites such as supplier sites or diabetes sites that say infrared is covered if a physical therapist is treating the patient, says Marvel Hammer, RN, CPC, CHCO, of MJH Consulting in Denver.

In addition, some practices "may have been billing infrared therapy under the infrared CPT® code, not realizing that there were also individual Medicare LCDs out there that addressed this therapy" from the start, she adds.

The facts: Medicare will not cover treatments using infrared therapy devices for diabetic and non-diabetic sensory neuropathy, wounds and ulcers. This includes using infrared therapy to treat related pain. Non-covered therapies include monochromatic infrared energy (MIRE), according to decision memo CAG-00291N.

Inform Your Patients

If you’ve been using forms of infrared therapy in your facility, you should tell your Medicare patients that they will be responsible for payment. And you will probably want to investigate your private payers as well because "most will follow Medicare’s lead eventually," says Meryl Freeman, MS, PT, manager of outpatient rehab at Rex Healthcare in Raleigh, N.C.

For your Medicare patients, have the Advance Beneficiary Notice (ABN) form ready. Depending on the reason you want to use the infrared therapy, "you might want to use an ABN," Hammer says.

Reason: The ABN is a required Medicare notice for a service that Medicare will most likely not cover (as opposed to a service that it never covers). Because the new coverage determination specifically prohibits coverage of infrared therapy for neuropathy, perhaps a therapist would have luck submitting an ABN for infrared treatments not related to neuropathies, Hammer says.

Don’t miss: Medicare will still cover actual physical therapy treatments, if the diagnosis is medically necessary, Freeman says. "The challenge will be that home units are also non-covered now, which defeats the purpose of the infrared-plus-PT treatment," which has been one of the few effective treatments for diabetic peripheral neuropathy, she adds.