![]() While the code S9090 is the one stated by most carriers to use, they also may have a policy that it is not to be reimbursed, noting the CMS stance on the service. Medicare requires the use of 97799 "unlisted physical medicine/rehabilitation service," with modifier GY and the explanation in block 19 of the 1500 form to state "VAV-D." I have researched several insurance carriers and have found that AmeriHealth, Blue Cross and Blue Shield, CIGNA Health Care, UNICARE, United Healthcare, Regence and Humana all note the billing for a spinal decompression unit should be with S9090. However, FDA approval does not necessarily equate to efficacy of use and the service may still be denied as not reasonable or necessary. Manufacturers of the devices use as a sales tool the fact that spinal decompression units are FDA-approved, which they are. These denials were based on the Medicare (CMS) ruling that spinal decompression had insufficient data to support the benefits of its use. However, payments did not persist and were eventually denied. The code S9090 has been around for a few years and, when initially introduced, was being paid by many Blue Cross and Blue Shield plans. I am concerned that these payments will later be reviewed and further payments for the code will not be made. I recently received information from several California providers that they were getting reimbursed $140 a session for S9090 from Blue Cross. In other words, it is billed once per treatment session.īased on the code that best describes the service, S9090 certainly fits that category. ![]() The code is noted as "per session" and indicates the amount of time or number of regions for which the unit is used, which is not relevant to its billing. In the HCPCS coding system, there is a code to describe "vertebral axial decompression," and that code is S9090. But for insurance billing purposes, spinal decompression does not have a specific CPT code to describe the services of spinal decompression. Is there a code for using this machine?Ī: Spinal decompression machines - vertebral axial decompression - have become quite popular and appear to be offering some positive responses to disc patients, at least empirically. That seems odd to me, since it is a traction device. ![]() Q: I have a new spinal decompression unit and have been told I can bill for heat, therapeutic activities, electrical stimulation, joint mobilization and exercise when I use it. ![]()
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