CLINICAL

This topic covers biophysical agents used to treat wounds. Interventions include electromagnetic stimulation (ES), pulsed electromagnetic field therapy (EMT/PEMF), diathermy, therapeutic ultrasound and phototherapy. Negative pressure wound therapy and hyperbaric oxygen therapy are discussed separately. (See topics "Negative Pressure Wound Therapy", and  "An Introduction to Hyperbaric Oxygen Therapy"). This topic will be expanded to include clinical information soon. A list of Medicare national and local coverage determinations can be found under section 'Coding, Coverage and Reimbursement' below.

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CODING, COVERAGE AND REIMBURSEMENT

Relevant Medicare National Coverage Determinations

• National Coverage Determination (NCD) for Infrared Therapy Devices (270.6) [1] 
• National Coverage Determination (NCD) for Noncontact Normothermic Wound Therapy (NNWT) (270.2) [2]
• National Coverage Determination (NCD) for Electrical Stimulation (ES) and Electromagnetic Therapy for the Treatment of Wounds (270.1) [3]
  

Medicare Administrative Contractors and Local Coverage Determinations

Medicare coverage of provider and facility fees related to application of CTPs is managed by Medicare Administrative Contractors (MAC), under Medicare Part A or Part B. Each jurisdiction may have its own specific local coverage determination and policies, as follows:

• Novitas Solutions, Inc.
• • Local Coverage Determination (LCD): Therapy and Rehabilitation Services (PT, OT) (L35036) [4] 
  • Local Coverage Determination (LCD): Wound Care (L35125) [5]
    
• CGS Administrators, LLC:
• • Local Coverage Determination (LCD): Outpatient Physical and Occupational Therapy Services (L34049) [6]
  • Local Coverage Determination (LCD): Outpatient Physical Therapy (L34428) [7]
  • Local Coverage Article: Low frequency, non-contact, non-thermal ultrasound (CPT code 97610) (A56175) [8]
• Palmetto:
• Local Coverage Determination (LCD): Home Health Physical Therapy (L34564) [9]
• Local Coverage Determination (LCD): Outpatient Occupational Therapy (L34427) [10]
• Local Coverage Determination (LCD): Outpatient Physical Therapy (L34428) [7]
• Local Coverage Article: Low frequency, non-contact, non-thermal ultrasound (CPT code 97610) (A54555) [11]
• Local Coverage Article: Low frequency, non-contact, non-thermal ultrasound (CPT code 97610) (A53773) [12]
  
• First Coast Service Options, Inc. (FCSO):
• • Local Coverage Determination (LCD): Therapy and Rehabilitation Services (L33413) [13]
  • Local Coverage Determination (LCD): Therapy Services billed by Physicians/Nonphysician Practitioners (L33961) [14]
  • Local Coverage Determination (LCD): Wound Care (L37166) [15]
    
• National Government Services, Inc. (NGS): 
• Local Coverage Determination (LCD): Outpatient Physical and Occupational Therapy Services (L33631) [16]
  
• Noridian:
• Local Coverage Determination (LCD): Treatment of Ulcers & Symptomatic Hyperkeratoses (L34199) [17]
• Wisconsin Physicians Service Insurance Corporation (WPS):
• Local Coverage Determination (LCD): Wound Care (L37228) [18]