While there are no CPT or HCPCS Level II codes specifically defined as "Light Therapy," depending on the nature of the procedure you are performing, a number of CPT codes may apply:

Bear in mind that depending on the nature of the procedure, the codes mentioned above may not apply. For instance, the Mayo Clinic, described on its website as the "largest integrated, not-for-profit group practice in the world," depicts "light therapy" as a standard form of care for treating "seasonal affective disorder" or SAD. Specifically, the Mayo Clinic describes at least one form of light therapy as follows:

"Seasonal affective disorder: Treatment with light therapy," The Mayo Clinic Web Site as of April 20, 2007.

Even more generally, Wikipedia describes to "light therapy" as follows:

Light Therapy, Wikipedia Web Site as of April 20, 2007

If the procedure you are performing is described by the Mayo Clinic / Wikipedia descriptions, the three CPT codes mentioned above would not seem to apply. In such instances, we would recommend that you bill the service as CPT Code, 97039, "Unlisted Modality."

Cold Laser Therapy is commonly referred to by many payers, manufacturers, and other authorities as "Low-Level Laser Therapy" and should not be confused with the types of "light therapy" referenced above (see, e.g., "Cold Laser Therapy," as discussed on the Wikipedia web site). While there is no CPT code that defines low-level laser therapy, there is a HCPCS Level II code – S8948 – that does reference the service. The S8948 code, which includes a time component, is defined as follows:

It is true that many workers compensation and personal injury carriers do not recognize HCPCS Level II codes and in such instances CPT 97039 is often used. Nevertheless, for reasons which are discussed below, whether in any given instance you use the 97039 ("unlisted modality") or S8948 code to express the service, we do recommend that you document, code, and bill the service consistently in terms of time. We say this for a number of reasons:

1. The AMA "Constant Attendance" Standard. All of the low-level laser therapy devices which we have seen, by their very design and nature, appear to require continuous manual application / constant attendance. One could potentially argue that there is a medical rationale why many manufacturers have designed their devices in this way - a point which is beyond the scope of this advisory. Under the AMA CPT Code system, all constant attendance modalities are expressed in terms of time.
2. Medicare's Opinion. The HCPCS Level II codes are developed and maintained by Medicare. Arguably, when Medicare created the S8948 code, it essentially expressed its opinion that low-level laser therapy constitutes a constant attendance modality and as such should be expressed in terms of time.
3. The Opinion of Some Private Payers. Some private payers require you to use the S8948 code to express the low-level laser therapy service. To the extent private payers have required use of this code, to that extent have they expressed their opinion, arguably, that low-level laser therapy is a constant attendance modality and must be expressed in terms of time.
4. Consistency. As a practical matter, you may find it very difficult to express low-level laser therapy sometimes in terms of time and other times not in terms of time. Whether you have a right, or are entitled, to alternate between methods of documenting, coding, and billing for the same service is an entirely different matter.

It is true that documenting, coding, and billing a service in terms of time creates additional "headaches" for providers. Additionally, the reimbursement rules of carriers (e.g., the Medicare "8-minute" rule) diminish even further the desire to abide by the time requirement. This disincentive becomes even more pronounced when the care, such as low-level laser therapy, may not always require much in the way of time. Nevertheless, for the reasons discussed above, we do recommend that when it comes to low-level laser therapy, you adopt the time component into your documentation, coding, and billing practices. In a future advisory, we will address the issue of whether providers might be able to use the -52 modifier ("reduced services") when reporting time-based services.

Some providers attempt to code low-level laser therapy as "infrared [supervised modality]" and thereby avoid the time requirement. We do not recommend this practice for several reasons. First, according to the AMA CPT Assistant, infrared must raise the temperature of tissues 5 to 10 degrees centigrade. Second, there may be a medical rationale as to why many manufacturers have designed and developed their low-level laser devices as constant attendance units. we strongly recommend that before simply assuming that low-level laser does not require constant attendance from a medical standpoint you review the scientific literature on this point. Third, many payers expressly say that they do not reimburse for low-level laser therapy except, perhaps, in limited instances, e.g., carpal tunnel syndrome for FEP programs. If you adopt a code which is likely to be reimbursed where otherwise no reimbursement should have been made, and you get paid for the service, you could be exposing your practice to the risk of audit and recoupment.

As a result of the foregoing, some providers elect to simply deliver the low-level laser service as a "cash" item, meaning that they deliver the service, but then do not actually send a bill to the payer. Bear in mind that you may be required either by law (state or federal) or by contract to submit all charges to a payer, and possibly also to notify your patients of the likelihood of non-reimbursement. Before taking this route, you should contact the various payers and check with coding and legal professional.