Does Medicare Cover Laser Treatment for Neuropathy?
Understand Medicare's stance on laser treatment for neuropathy. Learn if this innovative therapy is covered and what factors influence coverage decisions.
Medicare is a federal health insurance program for Americans aged 65 or older and certain younger people with disabilities. It helps beneficiaries manage healthcare costs for various medical conditions. Neuropathy, a condition involving nerve damage, causes symptoms like pain, numbness, and tingling. This article clarifies Medicare’s approach to covering laser treatment for neuropathy.
Medicare Coverage Fundamentals
Original Medicare consists of two primary parts: Part A (Hospital Insurance) and Part B (Medical Insurance). Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services. Part B covers doctor’s visits, outpatient therapy, durable medical equipment, and other medical services received outside a hospital. Medicare Part D helps cover prescription drug costs.
Medicare determines coverage based on several criteria. Services must be medically necessary, meaning they are appropriate for diagnosing or treating a condition. They must also be reasonable, aligning with accepted medical standards. Medicare generally does not cover treatments considered experimental or investigational. Food and Drug Administration (FDA) approval is a prerequisite for Medicare coverage, but FDA clearance alone does not guarantee coverage.
Medicare’s Stance on Laser Treatment for Neuropathy
Original Medicare does not cover laser treatment for neuropathy. The Centers for Medicare & Medicaid Services (CMS) considers infrared therapy devices, including those used for laser treatment, investigational or experimental for neuropathy. This non-coverage extends to both diabetic and non-diabetic neuropathy due to insufficient evidence of effectiveness. National Coverage Determination (NCD) 270.6 states that infrared and/or near-infrared light and/or heat is not covered for neuropathy or its symptoms.
More research is needed to confirm the effectiveness of laser treatment for neuropathy. Until sufficient evidence supports its efficacy, Medicare maintains its non-coverage. While Medicare may cover routine costs associated with qualifying clinical trials, it generally does not cover the experimental treatment itself. Therefore, Medicare covers only the routine care and complications, not the laser therapy itself, if participating in a clinical trial for laser treatment for neuropathy.
Determining Coverage and Patient Responsibility
Before receiving any medical service, patients should discuss coverage with their healthcare provider. Providers can help determine if a service is likely to be covered by Medicare based on medical necessity and established guidelines. If a provider believes Medicare may not cover a service, they are required to issue an Advance Beneficiary Notice of Noncoverage (ABN).
An ABN is a written notice informing the Medicare beneficiary that Medicare is expected to deny payment. This notice transfers the potential financial responsibility to the patient, allowing them to make an informed decision about whether to proceed with the service and accept the out-of-pocket cost. If a service were to be covered by Original Medicare Part B, beneficiaries would pay an annual deductible, which is $257 in 2025, and then a 20% coinsurance of the Medicare-approved amount for most services, after the deductible is met. Medicare Advantage (Part C) plans must cover at least what Original Medicare covers, but they may have different cost-sharing rules, networks, or specific policies regarding experimental treatments.