“Which code should be billed for Spinal Decompression to get it paid by insurance?” is a common question asked by many patients seeking Spinal Decompression Therapy.
Unfortunately, the answer is both simple and complex at the exact same time!
Simple Answer:
The ONLY codes that can be billed to the insurance company are the CPT codes of the services that the doctor performed on the patient. Unfortunately, the only appropriate codes for Spinal Decompression reimburse little to nothing.
The Slightly More Complex Answer:
The two most commonly billed codes for Spinal Decompression are S9090 and 97012. These are referred to as CPT codes and are used to code (describe the service performed) and bill the insurance company.
S9090: “Vertebral Axial Distraction” (this is where the – now horribly outdated – Vax-D got its name)
97012: “Application of a modality to one or more areas, traction, mechanical”. Spinal Decompression is NOT traction, but some insurance companies view it that way.
S9090 seems to be the code that most private insurance companies prefer (although there are exceptions) while Medicare seems to prefer 97012.
Guess how much the average insurance company pays for either of these codes. That’s right. Little to nothing. The range is usually $0 to $20 per visit. At best an insurance company can be expected to pay for just a few hundred dollars of a $5,000 or more course of Spinal Decompression.
This is why most Spinal Decompression doctors tell you that there is “no insurance coverage for Spinal Decompression”. Essentially, this is true. If the only service that the doctor performed on the patient was Spinal Decompression then the only code that can legally be billed is a code that accurately represent Spinal Decompression (i.e., S9090 – Vax-D, 97012 Mechanical Traction).
The Irvine Spine and Rehab Answer:
Doctors can only bill for services that they perform. As we saw above the services called “Spinal Decompression” or “Vertebral Axial Distraction” or “Mechanical Traction” are either not paid for by most insurance companies or are paid at levels far too low to keep Spinal Decompression offices in business – the tables are hundreds of thousands of dollars each (and we have 5 of them).
So how can we bill (and get paid by) insurance companies for Spinal Decompression?
The answer is in our name: Irvine Spine and Rehab. We don’t just throw a person on a fancy Spinal Decompression table, cross our fingers and hope for the best. I hate to admit it, but we used to do that and we didn’t like it very much nor did our patients!
Only 1/3 of our Complete Spinal Rehabilitation Program is based on using the DRX9000 Spinal Decompression technology. The remaining 2/3 of the treatment is direct hands-on therapy by one of our highly trained rehabilitation staff. The benefit to the patient is two-fold: 1) much higher quality of care, and 2) much lower out-of-pocket cost to the patient (an average patient with a mid-level PPO insurance plan will pay less than half what they would at an office that does not accept insurance!).
Why don’t other offices do something similar? Easy: It’s really expensive. We currently have a staff that consists of four doctors, three assistants and one tech. If we weren’t providing direct hands-on rehabilitation treatment to every patient we could EASILY reduce our staffing down to just ONE DOCTOR and maybe ONE or TWO UNTRAINED TECHS. We could, but, of course, we wouldn’t be able to offer “Covered by Insurance” to our patients and the quality of care would suffer dramatically.
I hope this answers the question.
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A definite great read…
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I read a lot of blogs on a daily basis and for the most part, people lack substance but, I just wanted to make a quick comment to say I’m glad I found your blog. Thanks, 
A definite great read..Jim Bean
Spinal Decompresion therapy is not paid by any insurance companies is the billing code is S9090.
But I wonder how the code of 97012 can be used.
I am going through this right now, and it is not reimburseable with even Blue Cross. I figure it this way, it probably never will. Basically the insurance companies will pay for all the bak surgeries and stuff but that won’t pay for something can prevent back surgery. Yes I been told I might consider back surgery for degentative disc disease, but my question is this? How many am I going to need, yes how many, as i have seen too many failed back surgeries, too many redo’s repeats and too many people seeking disability because of back problems, and they were told it was all in their head and they could work.
So this is why, i considered decompression spinal theapy.
1) Your point about the S9090 vs. 97012 billing codes is correct. Most insurance companies will not pay for this code at all. When they do it is usually just a few dollars per treatment. That is why our office has revolutionized the delivery of Spinal Decompression to our patients by “taking the Spinal Decompression out of Spinal Decompression”! In other words, performing other ancillary services that are covered by insurance to dramatically reduce the cost of the total program.
2) Regarding: “How many back surgeries will I need?” This is a GREAT question. I have made a note to write and entire post around this question so be sure to look for it. It has probably been about a year since I thoroughly researched this topic so I am drawing this entirely from memory, but here goes. The short answer is that it is VERY common for patients to ‘repeat’ a spinal surgery about every 7-10 years. This may not be a problem for an 80 year-old patient, but for someone in their 30′s, 40′s, 50′s, etc. this can be a rather shocking statistic. I will find the actual published reference and post it in a separate post.
The “surgery every 7-10 years” statistic has been firmly established for lumbar spinal fusion surgeries. It was once believed that this did not apply to other so-called ‘less invasive’ surgeries like laminectomies, discectomies, microdiscectomies and the like. However, recent evidence (about a year back, anyway, like I said before) has pointed to all lumbar spinal surgery patients requiring some form of aggressive intervention (usually surgery) for the spinal discs located either above or below the surgically treated disc level.
In our office we commonly see patients seeking Spinal Decompression years after having received ‘successful’ spinal surgery. The patients often report good results from the surgery and usually speak rather highly about their surgeon, but when I tell them that it is VERY common for patients to require ‘repeat’ surgeries they are often troubled that their surgeon didn’t tell them that. I have personally seen discs degenerate to the point of requiring Spinal Decompression within 3 years of having back surgery. I can definitely tell you that the 7-10 year number holds up very well in the patients that we have seen over the years.
On a side note, I would say that nearly half the patients that I have seen that have received spinal surgery tell me that they were operated on “by the best surgeon in all of Southern California”. I find this very hard to believe considering that it is rare that any of those patients received surgery from the same doc! I like to think that I am the “Best Spinal Decompression Doctor in All of Southern California” and our results certainly put us in the running, but I know several docs in SoCal that are doing fantastic work getting people better without surgery. Word to the wise – the next time someone tells you they are the best at what they do, it is highly likely that they are not. The best docs don’t need to toot their own horns – their patients, their staff, other doctors and their visible results will toot the horn for them. Food for thought.
I hope this answers your question.
I answered your question more thoroughly in a separate post. I actually learned a few things myself when I was doing the research for your answer! One thing I do know – I don’t ever want to get back surgery if I can avoid it!
Here’s the link to the article on this Orange County Spinal Decompression Blog:
http://spinaldecompression-orangecounty.com/2009/10/17/back-surgery-how-many-back-surgeries-will-i-need/
I hope this answers your question. Please feel free to comment again if it does not.
Hi,
thanks for the great quality of your blog, every time i come here, i’m amazed.
So help me to understand this more clearly: if I go to a doctor’s office and I am looking for care for my back and the doctor uses other therapies for my back along with decompression my insurance can be billed and may pay for other therapies because they are related to rehabilitation for my back?
In a nutshell, Spinal Decompression is not a covered service under most insurance plans. However, Physical Therapy usually is covered. Therefore, our Complete Spinal Rehabilitation Program combines Spinal Decompression and Physical Therapy. Since we ‘shift’ most of the cost of the program toward the Physical Therapy services, the out-of-pocket cost will often be FAR less than it would be at an office that does not accept any form of insurance coverage for Spinal Decompression.
Not only is the cost of the program less, but our treatment effectiveness has improved considerably since we added Physical Therapy to our program. While Spinal Decompression treats the damaged disc and the source of the pain, Physical Therapy focuses on the mechanical and postural issues that caused the disc injury in the first place. By treating the cause the patient responds better, faster and is less likely to experience a future relapse!