shockwave therapy (California)

The filing and enforcement of liens (different states refer to these with different terms) to secure payment for services or goods against a workers' compensation award is complex and filled with special rules - this category is for questions and discussion of this special area of work comp law.

shockwave therapy (California)

Postby lacompfun on Wed Jun 17, 2015 6:19 pm

Is their a limit on sessions? What the going rate per official fee schedule?

providers claim $ 2,100 per session yet I am seing bill reviews at $ 423 per session...
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Joined: Mon Mar 09, 2015 11:58 am

Re: shockwave therapy (California)

Postby on Thu Jun 18, 2015 12:07 pm

Extracorporeal Shock Wave Therapy for Orthopedic Conditions (non-renal) for any indication other than plantar fasciitis is experimental and investigational and therefore non-approved because there is insufficient evidence in the peer-reviewed medical literature of the effectiveness of this procedure. So the elephant in the room is . . . What did UR say?

Shockwave therapy is recognized as effective only for treatment of plantar fasciitis, CPT 28890. This CPT code is not listed in the OMFS. Claims adjusters and bill reviewers are taught to analogize procedures for which there is no RVS to defined procedures that require similar resources. IBR won't address procedures not included in the OMFS. Best (and most cost-effective) practice is for adjuster to call provider and negotiate a settlement -- this will forestall a lien filing, potential WCAB appearances, and a file lingering in open status.

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