How do I bill for treatment with the Stimpod NMS460 in the USA?
by Dr Stuart R. Humberg
The Stimpod NMS460 is a noninvasive neuromodulation device utilizing a patented pulsed radiofrequency waveform that is applied to the patient’s affected area transcutaneously.
Due to the complexity of the device and the ongoing nature of the patient’s response during the course of treatment, it requires constant attendance during use.
While federal anti-trust laws prevent providers from discussing and agreeing upon fees, there are several sites that will allow you a glimpse into what various insurance providers may pay.
The following information, while not directly discussing fees, may provide insight into how one may proceed in establishing the Stimpod NMS460 as a profitable therapeutic device capable of providing much-needed relief for the patients that you serve.
In the States, we have a multitude of ways in which a Chiropractor (or any provider) is reimbursed for treatment rendered to a patient. These ways include, but are not limited to the following:
- Private pay (cash)
- Health insurance which may include Medicare and/or Medicaid type policies
- Personal injury
- Worker’s Compensation
There are several options to consider when dealing with the “cash” patient. One can either chose to charge the patient for each individual time that the device is utilized (time of service) or another option to consider would be to provide a “package” of treatments in which a discount is given for payment in advance of the treatments being rendered. Lastly, it is not uncommon for the Chiropractor to present a case fee for a patient’s particular condition in which the device is utilized, but is absorbed in the overall cost of the treatment plan.
Medicare and/or Medicaid will typically only pay for spinal manipulation to be provided by the Chiropractor. Therefore, the thoughts pertaining to the “cash” patient would also apply to whatever therapy that you consider being beneficial to them and should be treated as such. A notable exception would be the importance of advising the patient that you do not believe that Medicare will pay for the service and have them sign the “Advance Beneficiary Notice of Noncoverage” form. This form will notify the patient that they are financially responsible for this non-covered service.
The remaining third party payers will typically require a CPT code when filing a claim for a service to be reimbursed so we will now turn our attention to this matter.
According to the AMA, “constant attendance” requires direct (one-on-one) patient contact by either the physician or other qualified health care profession. As earlier stated, the Stimpod NMS460 requires constant attendance. As such, there are several codes which may be utilized:
- 97032 – Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes (1 or more areas).
- 97039 – Unlisted modality (utilized when there is no accurate code for your modality). It is recommended that you note the code and then list the device and that it is FDA approved for symptomatic relief and management of chronic intractable pain. Also, the device is noted as helping increase range of motion and strength in associated muscles, so there are some methods of treatment utilizing the device in which a therapeutic procedure can be used. These type of codes are used when a direct (one-on-one) contact between the provider and the patient is utilized in an “attempt to improve function”.
- 97110 – Therapeutic exercise to develop strength and endurance, range of motion and flexibility, each 15 minutes.
Now for a few brief comments regarding time-based therapies: the CMS (Center for Medicare and Medicaid Services) adopted a policy of rounding up times to the nearest fifteen minutes in order to control fraud. With this in mind, 8 through 22 minutes would be considered one fifteen minute unit of care.
Lastly, it is up to the individual practitioner to do their due diligence and to practice in a manner consistent with the state and federal laws of which they are a part of and to bill appropriately and in accordance with any insurance plan that they are in a contract with. The information has been provided here is meant as a guide and has followed concepts found in the ChiroCode DeskBook.