At SpineCare we bill Decompression under the CPT code 97012 as suggested by the American Chiropractic Association. In this scenario it is covered under most major medical insurance programs. Please see below for additional information and if you have any questions please call our office at (256) 461- 7775.
Vertebral Axial Decompression Therapy
Vertebral axial decompression therapy is described as an alternative, noninvasive, nonsurgical procedure of applying axial (Y-axis) traction to the spine. It can be used in the treatment of several conditions, including low back pain associated with lumbar disc herniation, degenerative disc disease, posterior facet syndrome, and radiculopathy. The clinical objectives of this therapy include relief of disabling low back pain and return to normal function. Length of the episode of care is partially dependent on the patient’s response to treatment.
CPT code 97012, Application of a modality to one or more areas, traction, mechanical, is intended to identify a procedure that creates a force to allow for separation between joint surfaces. The degree of traction is controlled through the amount of force (pounds or Newtons) allowed, duration (time) and angle of pull (degree) using mechanical means. Therefore code 97012 would be an appropriate code to report for various types of mechanical traction devices (eg, computerized/ motorized) including vertebral axial decompression.
CPT code 64722, Decompression, unspecified nerve(s) (specify) and CPT code 63030, Laminotomy (hemilaminectomy), with decompression of nerve root (s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; one interspace, lumbar are specific surgical codes and should not be reported to describe the vertebral axial decompression procedure.
NOTE: Many payers have developed individual policies regarding reimbursement for this procedure; therefore it is advisable to check for their specific reporting guidelines.
References:
CPT 2006
CPT Assistant; November 2004
Medicare National Coverage Determinations Manual; 160.16
Reprinted by permission from American Chiropractic Association.