shockwave therapy (California)

[lacompfun]

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...

[jonbrissman@verizon.net]

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.

JCB