Will Medicare pay for cold laser therapy?

Does Medicare cover cold laser therapy? The answer is no. There are few insurance policies that currently cover cold laser therapy, but you do have some options. Read this guide to help you with your health insurance comparisons.

Cold laser therapy (CLT), or low-level laser therapy (LLLT), is a new and promising treatment for a wide variety of ailments. Unfortunately, while approved by the Food and Drug Administration, this treatment is still considered experimental.

 Although Medicare doesn’t cover this treatment, a good Medicare Supplement plan will cover a wide variety of other treatments. When you’re ready to start your search for the best Medicare Supplement plan for you, enter your ZIP code above and start your search right away.

Is low level laser therapy covered by Medicare?

Medicare does not currently have coverage options for cold laser therapy. According to the Centers for Medicare and Medicaid, the use of cold therapy laser devices is not “reasonable and necessary” for treatment of Medicare beneficiaries.

Despite a wide range of applications and little downside, low-level laser therapy currently remains on the fringe of medical services. The effectiveness of the treatment remains controversial, and this has made it difficult to obtain coverage for the expense.

Most insurance companies are waiting for more research on cold lasers before committing to coverage. However, this is not true for all providers, so check your policy to be sure.

If you decide to undergo cold laser therapy without insurance, you will be likely be paying for it yourself. Treatments range from around $30 to $150 per session, and you might need ten to twenty sessions, so be prepared.

Now, let’s take a closer look at cold laser therapy and see if it’s right for you.

What is a cold laser?

A cold laser is a type of laser therapy that stimulates healing when applied directly to the skin. The light level being used is low when compared to other types of laser therapy.

Other methods of laser therapy heat the skin being treated, and thus cause a physical reaction in the affected tissue. However, cold laser therapy gets its name from the fact that it does not raise the temperature of the tissue being treated. 

How does cold laser therapy work?

This treatment works simply and well in several circumstances. The light is applied directly to the affected area and stimulates activity in the damaged cells. 

In a manner similar to photosynthesis in plants, the light is absorbed by the skin and the energy gained is used to stimulate healing. The application of red and near-infrared light results in regeneration of damaged cells.

When administered by a doctor, the procedure lasts only a few minutes. The treatment is painless, non-invasive, and silent. There is, of course, no heat generated, though some soothing, gentle vibrations have been experienced.

Low-level Laser Therapy Uses

A variety of ailments can be treated with cold lasers. All manner of tissue repair is possible through LLLT, so check with your doctor to see if your condition qualifies.

Pain and inflammation can be soothed with low-level lasers. Minor ligament damage and muscle strains respond well to the treatment. Acne, minor burns, and edema have all been treated successfully by dermatologists using cold laser therapy. 

Wounds which are slow to heal, such as those experienced by diabetic patients, have benefitted from this non-invasive procedure.

Dentists have successfully treated inflammation and wounds in the mouth with this technology.

Patients with chronic conditions like fibromyalgia, carpel tunnel syndrome and rheumatoid arthritis are all candidates for cold laser therapy.

While this list is long and continues to grow, there are some negatives associated with LLLT, so let’s have a look at those now.

Cold Laser Therapy Side Effects

As a treatment that requires no surgery or medication, cold laser therapy is able to boast nearly zero side effects. No pain or reactions of any kind are expected. There are, however, some less than ideal aspects of the therapy.

In rare cases patients experience the recurrence of old injuries on the site being treated, but this condition is temporary and short-lived. CLT or LLLT should not be used on active bleeding sites or tattoos. 

Use of cold lasers in the eyes presents obvious problems and should never be attempted. In addition, patients with cancer, epilepsy, pacemakers, or who are pregnant are not candidates for low-level laser therapy.

Often cold laser therapy takes several treatments over several weeks to take effect. Some patients experience a lack of effectiveness due to overuse of cold lasers. Further research is needed to more accurately establish the ideal number of treatments needed for each condition. 

It should be noted that in all cases a doctor or qualified practitioner should administer the treatment. It is possible to obtain cold laser therapy treatment for use in the home, but the potential for serious injury is much greater.

Case Studies: Medicare Coverage for Cold Laser Therapy

Case Study 1: Maria’s Experience

Maria, a Medicare beneficiary, suffered from chronic knee pain due to osteoarthritis. After trying various conventional treatments without success, she opted for cold laser therapy as a non-invasive alternative. Maria submitted a claim to Medicare for reimbursement, supported by medical documentation and a recommendation from her healthcare provider.

Despite the compelling evidence, Medicare denied coverage, citing cold laser therapy as an experimental treatment. Maria was responsible for the full cost of the therapy.

Case Study 2: John’s Journey

John, an elderly Medicare recipient, sought cold laser therapy for a recurring shoulder injury. His healthcare provider recommended the treatment as a potential solution to manage pain and aid in the healing process. John’s case was different from Maria’s, as his Medicare Advantage plan covered cold laser therapy under specific conditions.

The therapy was approved for a limited number of sessions, subject to pre-authorization and medical necessity. Consequently, John received partial coverage for his treatment, with some out-of-pocket expenses.

Case Study 3: Sarah’s Struggle

Sarah, a Medicare enrollee with chronic back pain, was prescribed a series of cold laser therapy sessions by her physical therapist. The therapy was deemed medically necessary to improve her mobility and quality of life. Sarah’s Medicare coverage initially denied the claim, considering cold laser therapy as an alternative and investigational treatment.

However, Sarah and her healthcare provider appealed the decision, emphasizing the therapy’s positive outcomes in similar cases. After a thorough review, Medicare overturned the initial denial and granted coverage for Sarah’s treatment.

Case Study 4: Robert’s Reimbursement

Robert, a Medicare Advantage plan member, received cold laser therapy for a sports-related injury. His treatment was administered by a licensed and Medicare-approved healthcare provider. Robert’s plan had specific provisions that covered cold laser therapy as part of its complementary and alternative medicine benefits.

As a result, Robert was eligible for partial reimbursement for his therapy sessions, subject to his plan’s copayment and coverage limits.

Cold Laser Therapy and Medicare: The Bottom Line

We’ve seen that Medicare or private insurance coverage for CLT is hard to come by, so you will probably have to risk the out-of-pocket expense. The good news is there is little to no other downside to low-level laser therapy.

Check with your doctor and see if this treatment could make your life better. Still have questions? Enter your ZIP code below and we can help you find the Medicare solutions to fit your needs.