Please Don’t Bill Insurance for Your Hydro-Bed Modality!

A Hydro-Bed modality, aka hydrotherapy table, water massager, aqua table or hydro-massager, is a device in which water is used to administer a massage-type therapy. These devices are usually in a table format and are available in several variations. There are full or half body, and they can be heated or not. Some have adjustable time and therapy settings while others simply run on a timer. In each of these instances, the patient does not come into direct contact with the water. And this is really important… read on!

The Usual Technique

The water is contained in a “bladder” and dispersed through a device within the bladder in a whirlpool like manner. The device can vary in its technique, but the water is usually sprayed upwards onto the bladder, which is in direct contact with the patient’s body that is lying on the table. In tables where the water is heated, the temperature can be adjusted, usually from 70°F to 170°F. The benefit of using heat with this type of therapy is the increase in circulation in both the blood and the lymphatic system. Because this heat is administered through water, it is much easier for the patient to tolerate. The spraying action of the internal devices act as a “massager.” Although this is not considered massage therapy (97124), it does have similar benefits for the patient. The massage technique can be administered in many areas of the body by changing positions on the table. A patient can lay in the prone position (face down) or the supine position (face up) to ensure that placement of the massager is on the targeted body area. For example, treatment can be directed to the legs, low back, neck, or shoulders based on positioning. With many of these tables, the patient or physician can adjust not only the amount of pressure (12 to 17 lbs.) that is administered, but also the duration of time (3 to 30 minutes). An average treatment is around 10-15 minutes.

Billing and Coding

All of this sounds like it would obviously demonstrate “medically necessary” to any third-party payer, right? Not so fast. You must know the answer to two questions.

Will the payer consider it medically necessary? It’s critical to know the rules of every payer you do business with. Their Medical Review Policy is the guide that outlines their definitions of what is considered covered and what is not. Nearly every payer has purposely listed the Hydro-Bed modality as “not medically necessary” or in some cases, “experimental, investigational, and unproven.” Some go so far as to clarify that because it doesn’t require clinical skill to recommend it, it can’t be a covered service. What does this mean for you? Don’t submit to the carrier expecting reimbursement. Collect cash from the patient. In some cases, the carrier may require that you obtain advance approval in writing that the patient knows this is not covered and is willing to pay for the service out-of-pocket.

How do I code properly to describe the service? Let’s be clear. This is NOT coded as 97022, Whirlpool. The definition of 97022 is that, in some way, the patient gets in or out of a water environment. Since there is not a designated code for the Hydro-Bed modality, the most appropriate code is 97039, Unlisted Modality. Because it can mean anything, if you do have to submit the service on a billing form, send along some kind of description with your billing. Hopefully, in this circumstance, it will automatically be denied and assigned to patient responsibility.

This isn’t a suggestion to avoid offering this service in your office. It serves a specific purpose and is something patients will readily pay cash for…just check your local mall and notice that people self-serve to these devices all the time. Hence, the carrier impression that clinical skill isn’t required, due to that high-school senior running the thing in the mall. Please understand that nobody is suggesting that you not use this modality in your office. Just do it correctly. Best practice is to consider it a cash process and have the patient pay an additional, small copayment each time it’s used. Heck, it’s probably more effective than that “car wash” device at the mall!