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Medical Policy

Policy Num:       02.001.025
Policy Name:     HIGH INTENSITY LASER THERAPY
Policy ID:          [02.001.025]   [Ac / L / M- / P- ]   [0.00.00]

Last Review:       November 9, 2022
Next Review:      ARCHIVE POLICY
 

Related Policies: 

None

HIGH INTENSITY LASER THERAPY

Summary

Conventional laser therapy has been used in Europe for more than 25 years. Up to this moment, this therapy has consisted in the use of low or medium intensity devices. Their results have raised interest, although their effectiveness has not been proven by studies of long-term controlled results. Its use has been limited to superficial tissues since the

doses of energy necessary to treat deep tissues induce thermal damage to these.

Objective

The purpose of this review is to examine the effects of high intensity laser therapy (HILT) on pain and function in patients.

Policy Statements

High intensity laser therapy in cases of osteoarthritis, trauma and back pain is not considered for payment. This treatment modality has not been evaluated by the New

Technology Evaluation Committee of the BCBSA. There are also no randomized controlled studies on its long-term efficacy.

Policy Guidelines

No specific CPT codes exists for this procedure.

Benefit Application

BlueCard/National Account Issues

Not applicable

Background

Recently, high intensity laser therapy (HILT) has been introduced. It is postulated that HILT has the capacity of power and energy necessary to treat deep

inflammatory conditions, is not toxic and does not cause damage to the surrounding tissues to the pathology. Its effectiveness is due to its high pulse power, it

has a particular frequency and a large pulse amplitude. Due to these characteristics, a correct dose of energy can be applied to deep tissues. HILT is able to

produce a considerable photomechanical effect with a real pressure wave that propagates in the tissues. It acts directly facilitating lymphatic drainage and on

the inflammatory process, even though it is chronic. It has the ability to stimulate the production of collagen and the regeneration of hyaline cartilage.

Its use has been postulated in the management of osteoarthritis, cases of trauma and pain management in the lower back secondary to a herniated nucleus

pulposus.
 

Regulatory Status

FDA approved a HILT device through article 510 (k) in September 2005. This device is manufactured by an Italian company and in its temporary approval is quoted: "" is intended

to provide topical heating for the purpose of elevating tissue temperature for temporary relief of muscle and joint pain and stiffness, arthritis pain, or muscle spasm, the temporary

increase in local blood circulation and/or promoting relaxation of muscle.

Rationale

This treatment modality has not been evaluated by the New Technology Evaluation Committee of the BCBSA. There are also no randomized controlled studies on its long-term efficacy.

Promotion of greater diversity and inclusion in clinical research of historically marginalized groups (e.g., People of Color [African-American, Asian, Black, Latino and Native American]; LGBTQIA (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual); Women; and People with Disabilities [Physical and Invisible]) allows policy populations to be more reflective of and findings more applicable to our diverse members. While we also strive to use inclusive language related to these groups in our policies, use of gender-specific nouns (e.g., women, men, sisters, etc.) will continue when reflective of language used in publications describing study populations.

Population Reference No. 1 Policy Statement

Osteoarthritis and degenerative joint disease

Individuals with pain and functional limitations due to osteoarthritis and degenerative joint disease. Interventions of interest are the effects of HILT on pain and function in patients. Comparators of interest are standard therapy and surgical and non-surgical.  Relevant outcomes include quality of life, function improvement and relief of pain.

Supplemental Information

N/A

Practice Guidelines and Position Statements

N/A

Medicare National Coverage

Not applicable

References

1. Manetta J, Franz LH, Moon C, et al. : Comparison of hip and knee muscle moments in subjects with and without knee pain. Gait Posture, 2002, 16: 249–254. [PubMed]
2. Igawa T, Katsuhira J: Biomechanical analysis of stair descent in patients with knee osteoarthritis. J Phys Ther Sci, 2014, 26: 629–631. [PMC free article] [PubMed]
3. Al-Johani AH, Kachanathu SJ, Ramadan Hafez A, et al. : Comparative study of hamstring and quadriceps strengthening treatments in the management of knee osteoarthritis. J Phys Ther Sci, 2014, 26: 817–820. [PMC free article] [PubMed]
4. Yıldırıım MA, Uçar D, Öneş K: Comparison of therapeutic duration of therapeutic ultrasound in patients with knee osteoarthritis. J Phys Ther Sci, 2015, 27: 3667–3670.[PMC free article] [PubMed]
5. Santamato A, Solfrizzi V, Panza F, et al. : Short-term effects of high-intensity laser therapy versus ultrasound therapy in the treatment of people with subacromial impingement syndrome: a randomized clinical trial. Phys Ther, 2009, 89: 643–652. [PubMed]
6. Wi SY, Kang JH, Jang JH: Clinical feasibility of exercise game for depression treatment in older women with osteoarthritis: a pilot study. J Phys Ther Sci, 2013, 25: 165–167.
7. Kheshie AR, Alayat MS, Ali MM: High-intensity versus low-level laser therapy in the treatment of patients with knee osteoarthritis: a randomized controlled trial. Lasers Med Sci, 2014,29: 1371–1376. [PubMed]
8. Hart LG, Deyo RA, Cherkin DC. Physician office visits for low back pain. Frequency, clinical evaluation, and treatment patterns from a U.S. national survey. Spine (Phila Pa 1976) 1995; 20:11.
9. Alster TS, Lupton JR. Erbium:YAG cutaneous laser resurfacing. Dermatol Clin 2001; 19:453.

Codes

Applicable Modifiers

N/A

Policy History