June 28th, 2016
We Bill Hot/Cold Packs (97010) on many patient visits but are very rarely reimbursed by insurances. Why is this?
97010 is a service that is commonly not covered by payers or if it is covered, reimbursement is very minimal. This is due to a few reasons:
- Hot/cold packs (97010) is not a high "qualified" code. Meaning in general that the actual benefit of this service and need for this service is relatively low. From the payors' perspective, the same treatment objectives during a particular visit could be achieved without having to perform this service at all
- Medical Necessity. Remember that services submitted for third party processing and reimbursement must meet medical necessity requirements. This means that we must adhere to the standard definition of medical necessity when expecting third party coverage and reimbursement. It can be quite difficult to support medical necessity for hot/cold packs.
- Over utilization. Hot/cold packs historically have been performed on patients as part of a routine procedure in many offices. Meaning also that medical necessity was not properly demonstrated but also that practices performed this procedure for the purposes of routine and/or patient comfort instead.
While back in the 1990s and early 2000s these details were less of a factor to payers when determining coverage and benefits, recent years have resulted in more strict guidelines and greater enforcement of existing guidelines which has impacted the reimbursement of this code as well as others. Nonetheless, if by verifying benefits and/or reviewing individual payer policies, you find that there is still indeed coverage for this procedure, do be sure to consider the points above to best ensure that you are appropriately implementing and billing for this service.