Wiki LCD Medicare States it is a NONPAYABLE Shock-Wave Therapy

[schanderson]

Good day all,

My office is a Neurology and Pain Management specialty and the physician had me look into Shock-Wave therapy which is the CPT Code 0101T. According to the LCD from Medicare it is deemed experimental and not payable. However, some representative for the company my physician spoke with says its payable. As such, the claim was sent out and Medicare actually pays for it. My question is this common place for Medicare to swear they do not pay for a procedure and then turn around an actually pay for the procedure?

 

[kleger]

I was curious about this too. The LCD says non-payable but it is listed on the fee schedule. Typically, when it is non-payable there isn't a fee associated with it. Have you had any success with other payors paying it?

 

[iowagirl77]

I was curious about this too. The LCD says non-payable but it is listed on the fee schedule. Typically, when it is non-payable there isn't a fee associated with it. Have you had any success with other payors paying it?

Are you looking at a current LCD? I checked multiple states and they're only showing expired LCDs, so perhaps Medicare changed their stance on this.