“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S9090: “Vertebral Axial Distraction” (this is where the – now horribly outdated – Vax-D got its name)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.
