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Other Biophysical Agents

Other Biophysical Agents

Other Biophysical Agents

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]
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NOTE: This is a controlled document. This document is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.

REFERENCES

  1. Centers for Medicare and Medicaid Services. National Coverage Determination (NCD) for Infrared Therapy Devices (270.6) . 2007;.
  2. Centers for Medicare and Medicaid Services. National Coverage Determination (NCD) for Noncontact Normothermic WOUND Therapy (NNWT) (270.2) . 2002;.
  3. Centers for Medicare and Medicaid Services. National Coverage Determination (NCD) for Electrical Stimulation (ES) and Electromagnetic Therapy for the Treatment of WOUNDs (270.1) . 2004;.
  4. Novitas Solutions. Local Coverage Determination (LCD): Therapy and Rehabilitation Services (PT, OT) (L35036) . 2015;.
  5. Novitas Solutions. Local Coverage Determination (LCD): Wound Care (L35125) . 2015;.
  6. CGS Administrators. Local Coverage Determination (LCD): Outpatient Physical and Occupational Therapy Services (L34049) . 2015;.
  7. CGS Administrators. Local Coverage Determination (LCD): Outpatient Physical Therapy (L34428) . 2015;.
  8. CGS Administrators. Local Coverage Article: Low frequency, non-contact, non-thermal ultrasound (CPT code 97610) (A56175) . 2018;.
  9. Palmetto GBA. Local Coverage Determination (LCD): Home Health Physical Therapy (L34564) . 2015;.
  10. Palmetto GBA. Local Coverage Determination (LCD): Outpatient Occupational Therapy (L34427) . 2015;.
  11. Palmetto GBA. Local Coverage Article: Low frequency, non-contact, non-thermal ultrasound (CPT code 97610) (A54555) . 2015;.
  12. Palmetto GBA. Local Coverage Article: Low frequency, non-contact, non-thermal ultrasound (CPT code 97610) (A53773) . 2015;.
  13. First Coast Service Options. Local Coverage Determination (LCD): Therapy and Rehabilitation Services (L33413) . 2015;.
  14. First Coast Service Options. Local Coverage Determination (LCD): Therapy Services billed by Physicians/Nonphysician Practitioners (L33961) . 2015;.
  15. First Coast Service Options. Local Coverage Determination (LCD): Wound Care (L37166) . 2017;.
  16. National Government Services. Local Coverage Determination (LCD): Outpatient Physical and Occupational Therapy Services (L33631) . 2015;.
  17. Noridian. Local Coverage Determination (LCD): Treatment of Ulcers & Symptomatic Hyperkeratoses (L34199) . 2015;.
  18. Wisconsin Physicians Service Insurance Corporation. Local Coverage Determination (LCD): Wound Care (L37228) . 2018;.
Topic 1197 Version