Help, I can't find the medical procedure code

Factual Questions
1

I’m trying to submit a claim for reimbursement for a light therapy box for treatment of SAD. The insurance company sent the claim back saying I needed to provide a procedure code for them to process it.

I asked the insurance company, who said WE CAN’T GIVE YOU MEDICAL ADVICE and refused to tell me what the appropriate code was. (Note that the box was already purchased at this point, I’m just trying to get reimbursed.) He did, however, tell me that it would be considered “durable medical equipment.”

I’ve asked my mental health provider. She doesn’t have it on hand, and has been trying to track it down since January. No luck.

I’ve asked my GP doc. They don’t have procedure codes for anything they don’t handle/treat in the office, which does not include light therapy boxes.

Isn’t there a Big Book of Codes somewhere we can look this up? A library? A database? Where in hell do I find this @##@ procedure code?

Thanks.

2

Where do you live and who is your insurance company?

3

Chicago and Unicare. But aren’t procedure codes universal?

4

This may or may not be what you need; use at your own risk.

From the 2008* HCPCS Level II book:

E0203
Therapeutic lightbox, minimum 10,000 lux, table top model.

That’s the only “lightbox” I find. I dunno if it matches what you’ve got, but it’s a place to start looking.

I’d also recommend calling whomever you bought the box from (or another DME supplier that sells the same thing). They’d more than likely know how to bill it to insurance.

*I’m not sure who’s carried off my current HCPCS book; your doc should have access to a 2009 copy. You might want to check for changes.

5

Ha. Of course the obvious solution was the one I wasn’t thinking of.

Thanks, it seems to correspond to what you found. I’ll run this by my health provider and see what she says.

6

For future reference:

Free CPT lookup

HCPCS and ICD-9 codes

7

If you live in the US, and your insurance company uses the standard Medicare billing code (I think they have to), this page may tell you what you need to know

8

Okay, so now I wonder why this was so hard to find. Granted my mental health provider is a LCSW and not an MD, but she still has to submit claims to insurance, and so does my GP, so why not have the Big Book of Codes handy? Surely the book has an index to make searching easier, yes?

“Affective psychoses”? Cool! :cool: Nice to know I’m considered batshit crazy because winter makes me tired. :stuck_out_tongue:

9

Well, in fairness, any given doctor or other practitioner will mostly use a short list of ICD diagnostic codes and HPCPS treatment codes, and may not ever need or want to pay for the Big Book.