Dear Provider,
Unfortunately, as we know, the new BCNC physical therapy (PT) prior authorization (PA) program does not consider Mechanical Traction (97012) or Unattended Electrical Stim (97014) to be medically necessary. As such, BCNC will no longer cover these services for patients of BCNC fully insured commercial plans effective 11/1/24.
Importantly, however, you may still get paid for performing these specific services on BCNC fully insured commercial patients by collecting appropriately signed non-covered services waivers and billing the patients directly, without having to first request PA.
To assist you in this regard, HNS has created a Non-Covered Services Waiver for Traction and E-Stim form, which you may use for patients of fully insured BCNC commercial plans (effective 11/1/24), or any other patient of an insurance plan that does not cover these services.
Click Here for Your Copy of the Non-Covered Services Waiver for Traction and E-Stim
You may also find a copy of this Waiver, as well as other helpful forms, under the Forms Section of the HNS Website.
For more information on the proper procedure for billing patients for non-covered services, please consult HNS Non-Covered Services Policy found here: https://healthnetworksolutions.net/index.php/non-covered-services.
Sincerely,
HNS