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Does Medicare Cover Ionto?

September 12, 2015 0 Comments

Therapists always seem to ask “does Medicare cover ionto?”  There is a bit of urban legend that IontoMedicare does not cover this constant attendance modality, where in fact there is not a National Coverage Determination (NCD) that speaks to the use of ionto.

According to the clinical responsibility description of iontophoresis at SuperCoder:

Iontophorehis (Ionto) is the introduction of a drug through intact skin by application of electric current into the tissues of the body. It most commonly use it to treat hyperhidrosis, which is excessive sweating of the hands, feet, and underarms. The provider applies the electric current by placing the part to be treated in water and then passing electricity through the water, gradually increasing the current. The procedure works by plugging the sweat glands. Providers also use it to treat certain inflammatory conditions like bursitis and fasciitis.

Iontophoresis is a constant attendance modality and can be used on multiple body parts in the same session and is billed in 15 minutes increments, which for Medicare means that the total direct treatment minutes are past of total timed code treatment minutes and billing is constrained per Medicare’s guidance, often referred to as the “eight minute rule”.

Does Medicare Cover Ionto  – Yes and No!

Coverage of iontophoresis is according to the local coverage determination (LCD) of your Medicare Administrative Contractor (MAC).  Interestingly enough the coverage of Ionto varies across the country depending on your MAC.

Medicare Coverage of Iontophoresis - LCD Examples

Medicare Administrative ContractorCoverage of Iontophoresis
NGSIontophoresis is the introduction into the tissues, by means of an electric current, of the ions of a chosen medication. This modality is used to reduce pain and edema caused by a local inflammatory process in soft tissue, e.g., tendonitis, bursitis.

The evidence from published, peer-reviewed literature is insufficient to conclude that the iontophoretic delivery of non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids is superior to placebo when used for the treatment of musculoskeletal disorders. Therefore, iontophoresis will not be covered for these indications.

Iontophoresis will be allowed for treatment of intractable, disabling primary focal hyperhidrosis (ICD-9-CM code 705.21) that has not been responsive to recognized standard therapy. Good hygiene measures, extra-strength antiperspirants (for axillary hyperhidrosis), and topical aluminum chloride should initially be tried.
CGSIontophoresis is the introduction into the tissues, by means of an electric current, of the ions of a chosen medication. This modality is used to reduce pain and edema caused by a local inflammatory process in soft tissue, e.g., tendonitis, bursitis.

The evidence from published, peer-reviewed literature is insufficient to conclude that the iontophoretic delivery of non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids is superior to placebo when used for the treatment of musculoskeletal disorders. Therefore, iontophoresis will not be covered for these indications.

Iontophoresis will be allowed for treatment of intractable, disabling primary focal hyperhidrosis (ICD-9-CM code 705.21) that has not been responsive to recognized standard therapy. Good hygiene measures, extra-strength antiperspirants (for axillary hyperhidrosis), and topical aluminum chloride should initially be tried.
NovitasIontophoresis is an intervention that uses the properties of electricity to introduce ions of soluble salts and medications (such as NSAIDS and/or analgesics) into tissue by means of an electric current. This modality is non-invasive and utilizes polarity differences to push the medication across the cell membranes.

This modality is used to reduce pain and edema caused by an inflammatory process such as tendonitis, bursitis, plantar fasciitis and lateral epicondylitis.
Palmetto GBAIontophoresis is a process in which electrically charged molecules or atoms are driven into tissue with an electrical field. Voltage provides the driving force.

This is a constant attendance code requiring direct, one-on-one patient contact by the provider. Only the actual time of the provider’s direct contact with the patient is covered.

If no objective and/or subjective improvement noted after 8 treatments, a change in treatment plan (alternative strategies) should be implemented or documentation should support the need for continued use of this modality. The efficacy of this modality should be met in at most 10-12 visits. Documentation must support the need for continued treatment with this modality for greater than 12 visits.

This modality should be used in conjunction with therapeutic procedures.

Coverage for iontophoresis when delivered by means of a '24 hour patch' is only for the time spent for the initial application and is generally covered for 1-2 visits to establish efficacy. Subsequent visits for reapplication generally do not require the skills of a licensed therapist and therefore are noncovered.
FCSOIontophoresis is a process in which electrically charged molecules or atoms (e.g., ions) are driven into tissue with an electric field. Voltage provides the driving force. Parameters such as drug polarity and electrophoretic mobility must be known in order to be able to assess whether iontophoresis can deliver therapeutic concentrations of a medication at sites in or below the skin.

The application of iontophoresis is considered medically necessary for the topical delivery of medications into a specific area of the body. The medication and dosage information may be recorded in the plan of treatment or maintained on a separate prescription signed by the health care provider responsible for certifying the plan of treatment.

Specific indications for the use of iontophoresis application include:
- the patient has tendonitis or calcific tendonitis; - the patient has bursitis; or - the patient has adhesive capsulitis.
WPSWPS has discontinued publication of a therapy LCD
NoridianNoridian has discontinued publication of a therapy LCD

Do you use Ionto for Medicare patients?  Do you know if your MAC covers Ionto? If your MAC covers Ionto do you know for which diagnoses?  If you use this modality in instances where it is non-covered do you know how to issue the patient an advanced beneficiary notice of non-coverage so that payment for the modality is recognized by Medicare as patient liability?

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Nancy Beckley

Nancy J. Beckley MS, MBA, CHC: President-Nancy Beckley & Associates LLC. Compliance outsourcing, risk assessment, compliance plans, compliance training, auditing, due diligence, investigation support for therapy providers.

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