Photonic Stimulator Billing

The safest way to bill is:

97026 Infrared: Chiropractors and physical therapists can bill for multiple areas treated by infrared light therapy. For example, a whiplash could be cervical, thoracic, and shoulder. It is possible to bill $10-$25 per area. When you bill for an additional area you bill a -59 (dash 59). A -59 means that a complete therapy session was applied to a separate area of the body. For example:

97026………..Infrared Lumbar Spine………...$25

97026-59….…Infrared Lower Extremity……..$25

97039 Attended Modality: With this code, practitioners should send a note with the bill explaining how the modality is used, including the time required for application. It is common to bill $20-$30 for this procedure. For example:

97039………..Attended Modality, Lumbar Spine……...$25

97039-59……Attended Modality, Lower Extremity..….$25

For a sample letter that practitioners can send to the insurance carrier, click here.

99211 or 99212: These codes describe an established patient office visit that lasts for approximately five or ten minutes, respectively. They are primarily medical codes and not commonly used by physical therapists and chiropractors. They tell the insurance company that the doctor spent time with the patient and provided an examination and therapy. If the doctor or his therapist/nurse/aid provides a brief evaluation plus light therapy, the billing should include a 99211 or 99212, plus a 97026 or 97039. It is legitimate for a doctor's nurse to bill a 99211 without the doctor being present.

99213: This code specifies an established patient office visit, 11-15 minutes. It is common for physicians to bill for almost any procedure with this code. The doctor can also bill for a modality in addition to the office visit.

Note: 98942 describes chiropractic manipulation; 98925-98929 is manipulation used by osteopathic physicians; and 97140 is physical therapy mobilization. These codes are used in addition to the PS stimulator codes, such as 97026, 97026-59, 97039, and 97039-59.

The most common billing pattern among practitioners is the "cocktail" or "a la carte." This means that the bill from an office visit could include some mobilization plus two or more modalities. For example, if a practitioner finds that her trigger point therapy (massage) is more effective with the PS, she may decrease massage time and add infrared. This practitioner could bill for infrared to one or two areas, plus heat and trigger point therapy, while spending the same amount of time she previously spent just providing heat and massage.

For a PT code chart outlining general reimbursement amounts, click here.