Laser therapy has become an indispensable part of the permanently growing expertise of present day medicine, pointing at the possibilities of its practical application in various fields, including dermatology, ophthalmology, and analgesia. Lasers ensure that surgeries are precise and require less incision, thus being advantageous to both the patients and surgeons. 

This blog helps you understand what laser therapy is, the significance of CPT codes in laser therapy, common CPT codes, challenges, and best practices for avoiding laser therapy billing issues.

What is Laser Therapy?

Laser treatment is a special medical treatment where light is used in order to treat the specific tissue of a particular organ in the body. Laser light is well defined for particular wavelengths, and as such, Lasers can be directed with relative ease. It can therefore be used in many contexts, including dermatology, for purposes such as scar removal, lesion or wrinkle reduction, and suppression of pain and inflammation in musculoskeletal disorders. Laser treatment can also be applied in eye diseases such as glaucoma or retinopathy diabetic. The procedure is usually carried out as a laparoscopic or endoscopic surgery, which entails a less invasive approach, allowing the patient to heal faster than in normal surgeries. 

Why are CPT Codes Important in Laser Therapy?

Laser therapy requires CPT codes in order to capture appropriate billing and reimbursement for services provided. These CPT codes are used in the health facilities to explain the treatment processes given to the patients. When choosing the CPT codes for laser therapy, the providers should use the appropriate codes so that insurers know the kind of treatment given to patients and thus assess their claims appropriately. Incomplete or improper code assignment results in claims being declined, delayed, or even paid less, which have impacts on the practice’s revenue. Furthermore, CPT codes contribute to compliance, accuracy of medical records, and adherence to the legal requirements—both within care provision and in administrative work.

Common CPT Codes for Laser Therapy

Laser therapy is used in many fields of medicine, and reimbursement depends upon the proper choice of CPT codes. Each code corresponds to a specific procedure that ensures accurate documentation, billing, and reimbursement for the rendered services. Here’s a breakdown of some common CPT codes for laser therapy:

Dermatology and Skin Procedures

Skin abnormalities such as benign lesions, hypertrophic scars, and rhytides commonly use lasers. The CPT codes used in these procedures are specific to dermatological applications.

• 17110: This code pertains to the surgical removal of benign lesions (excluding skin tags and cutaneous vascular lesions) on the skin, with a maximum number of 14 lesions. It often encompasses operations such as laser treatment, removal of warts, seborrheic keratosis, or any other lesions that are non-cancerous.
• 17111: Identical to 17110, but utilized when excising more than 15 benign lesions. If an individual has numerous large growths, multiple laser treatments may be necessary.
• 17360: This code includes chemical peeling treatments and lasers for diseases like acne. Dermatology often uses it for facial peels or any laser treatment that focuses on acne scar removal.
• 17999: This is a general code for laser procedures on skin, mucous membranes, and subcutaneous tissues, and it may be utilized in situations where a specific code for a particular type of LASER procedure is not available. This may include aesthetic laser operations such as tattoo removal or laser scar enhancement.

Ophthalmology

Ophthalmologists widely use laser treatment to manage pathologies such as glaucoma and retinopathy. Some specific CPT codes for ophthalmologic laser procedures are listed below:

•  65855: This procedure, specifically trabeculoplasty, uses laser surgery to treat glaucoma. The procedure aims to reduce eye pressure by enhancing fluid discharge.
•  67210: This code is for the laser treatment of prematurity retinopathy, a disease that occurs in prematurely born children’s eyes. Laser treatment in these cases is useful for preventing retinal detachment.
•  67228: Sought laser photocoagulation therapy in diabetic patients with progressive or severe retinopathy. This procedure means that using a laser, the doctor is able to weld all the blood vessels in the retina so that no more leakage occurs.

Musculoskeletal and Pain Management

Laser therapy in physical therapy and rehabilitation practices has become more popular in the alleviation of pain and inflammation, as well as the stimulation of the healing process. These treatments have the following CPT codes:

• 97032: This code incorporates electrical stimulation, a commonly used combination with laser therapy to enhance pain control and tissue healing. Though not an exclusive modality of therapy with laser treatment, it goes hand in hand with it.
• 97039: An unlisted modality code mostly applied in the treatment by laser procedure where there is no unique code. It could also feature Low Level Laser Therapy (LLLT), which is a therapeutic application utilized in pain management or to minimize inflammation or promote healing in different types of musculoskeletal injuries.

Vascular and Cosmetic Procedures

Laser therapy is used extensively in the treatment of various vascular disorders, such as varicose veins, and in aesthetic medicine. The following codes apply:

• 36475: This code is utilized for endovenous ablation of an incompetent vein by using laser therapy. This procedure deals with varicose veins, wherein it utilizes a laser to seal the vein by heating the area and thus diverting blood flow to better veins. 
• 17999: This code is used as an unlisted procedure code to refer to laser treatments where exposure codes do not exist, as well as cosmetic procedures, although it can be used for any other procedure. Some examples include helping patients permanently remove unwanted hair using laser, eradicating tattoos, or using laser to peel off the skin for face lift purposes.

Pain Management and Neurological Conditions

Laser therapy is sometimes integrated into treatments for pain management and certain neurological conditions. 

• 64616: This code includes chemodenervation of muscles that are in extreme spasms, like the muscles in the neck area that may require laser therapy in combination with other treatments like botulism toxin for problems like spasmodic torticollis.
•  97026: This code pertains to infrared therapy and laser therapy in analgesia that may be applied to the patient. Infrared lasers provide pain relief for conditions such as arthritis or soft tissue injuries.

Challenges in Laser Therapy Billing

Billing for laser therapy comes with several specific challenges:

Cosmetic vs. Medical Procedures

Most laser procedures are categorized as aesthetic and therefore not reimbursable, even if they fall within the health services category. It is therefore important for providers to clearly explain the medical need for the procedure to enable them to avoid cases of denied claims.

Use of Unlisted CPT Codes

Some laser therapies lack specific CPT codes, necessitating the use of unspecified codes like 17999. This can cause billing issues because payers may demand more supporting information or an explanation, which slows the claim payment processing.

Complexity of Code Selection

Different CPT codes apply to various laser treatments such as skin resurfacing, lesion excision, treatment of a malignancy, pain control, and others. Choosing an improper code may lead to underpayment or denial, and, thus, the best knowledge of CPT is required.

Documentation Requirements

Lack of clarity or missing information is likely to result in rejections. Thus, in order to meet procedure requirements, the practitioner must fully document all changes in the frequency of treatments, location of procedures, and reasons for such changes.

Frequent Insurance Scrutiny

Laser therapies, especially those that may entail cosmetic surgeries, are often on the list of treatments that insurance firms keep reviewing from time to time. This puts providers on their toes, and they must ensure they provide adequate evidence of the medical necessity and adequate documentation in order to avoid denials or even audits.

Variability in Coverage

Many insurance plans differ from one another regarding which laser procedures are to be compensated, and therefore not all resources are equal in this regard. It is important for providers to confirm coverage for each patient and treatment because different payers will have different sets of rules.

 Financial Implications of Incorrect Laser Therapy Billing

Laser therapy procedures are complex, and poor coding of these treatments could result in large financial implications for the healthcare organization. The specific financial impact of billing issues related to laser therapy includes:

Revenue Loss

Most laser therapy procedures, as in the case of anesthetic, chronic or skin reconstructing, or ophthalmologic surgery, are expensive. Lack of proper coding, which includes using the wrong CPT code, results in a claim denial and hence limits the payment that the provider gets, reflecting in the practice’s income.

Increased Administrative Costs

When patients’ laser therapy claims are rejected, administrative personnel need to spend extra time to study the rejection issue, seek necessary documents, and renew the claim. As the laser treatment is highly specialized, this process also requires consulting with the clinical staff, which is time-consuming and increases the operational costs.

Potential for Audits

Laser therapy is utilized for aesthetic and clinical applications, which put these procedures in a vague area concerning insurance reimbursement.  Inaccurate billing, especially in cases of operations that insurance companies may consider cosmetic, leads to audits.

Patient Dissatisfaction and Financial Responsibility

Incorrect bills lead to significant reimbursement costs for patients, particularly when a claim is denied due to incorrect coding or insufficient medical necessity documentation. When patients receive surprise bills for their laser therapy treatments, it may frustrate them and cause them to not return to the practice in the future, which harms the practice’s image.

Best Practices for Avoiding Laser Therapy Billing Issues

Optimal billing for laser therapy could be challenging, but these recommendations will help billing specialists avoid possible pitfalls resulting in claim denial and prolonged waiting for reimbursement. Here are some critical steps to streamline the billing process for laser therapy:

Obtain Prior Authorization

Some insurance providers expect a referral for laser therapy due to pre-authentication or some conditions, which can be determined as controversial in essence or if the treatment can be labeled as cosmetical. Ensure you:

•  Check the insurance plan of the patient before undertaking the procedure.
•  Discuss laser skin resurfacing, hair removal, or any other elective laser procedure with your practitioner and get written approval first.
•  Clearly explain the medical necessity for the treatment to the insurer when seeking authorization.

Use the Correct CPT Code

It is critical to properly code laser therapy in order to bill for the service under CPT codes. Because laser treatment can be applied to various fields of medicine, choosing the right code helps to classify the treatment properly. If there isn’t a specific CPT code for the laser procedure:

•   Use an unlisted code like 17999 (for dermatology or cosmetic procedures) or 97039 (for physical therapy-related laser treatments).
•  Include a detailed explanation of the procedure when using an unlisted code to prevent delays or rejections.

Maintain Detailed Documentation

Sufficient documentation is essential for reimbursement and legal requirements. Make sure to:

• Document the type of laser used, the specific area treated, the number of lesions removed or treated, and any other procedural details.
•  Clearly state the medical necessity of the procedure, especially if the laser therapy could be classified as cosmetic.
•  Include relevant patient history, diagnosis, and the treatment plan to back up the need for laser therapy.

Train Billing and Coding Staff

Make sure that your billing and coding specialists are familiar with the details of laser therapy and the respective CPT codes. This helps prevent costly mistakes such as:

• Applying improper codes (for example, assigning a code from the list of aesthetic procedures while the treatment is required for health reasons).
• Reporting claims with either missing or wrong supporting documents.
• Claim denials due to a lack of clear understanding of required insurance coverage.

The reduced number of billing errors can be achieved by frequent staff training and therefore improving the whole process of claims.

Verify Coverage Before Treatment

Laser treatment is not always covered by insurance because insurers have different policies regarding the use of this procedure. Always:

•  Check with the patient’s insurance provider to confirm whether the laser treatment is covered under their plan.
•  Understand whether the procedure is covered fully or partially and if the patient will need to pay out-of-pocket for certain services.
•  Communicate with the patient about their financial responsibilities to avoid surprises or disputes later.

Conclusion

Laser operation is one of the most important and effective methods in the medical field that provides accurate and non-surgical treatments of different diseases. However, the billing process for laser therapy is not easy since it involves many CPT codes and requires detailed documentation to ensure the claims do not get rejected. Enhancing medical coding, ensuring accurate documentation of all forms, accurately verifying each patient’s insurance, and providing coders with accurate coding guidelines can enhance the billing process. 

For practices trying to fine-tune the billing operations, outsourcing laser therapy billing to MedHeave Medical Billing Services is one of the wise decisions because it ensures the best coding and proper revenue, giving the providers the chance to do what they like most—heal patients.