To maximize results from ESWT the physician or authorized user must identify the tenderest spot on the patient's foot and properly transfer shockwave energy from the handpiece. A coupling agent must be used and the handpiece applicator must be held perpendicular to the treatment surface with adequate pressure throughout the treatment. Partial contact and or inadequate pressure during treatment can result in a loss of energy delivery to the affected area, and will reduce the overall efficacy of the treatment, thus impacting the therapy's success rate.
Shockwave energy application to soft tissue without the use of anesthesia requires a continual energy density adjustment to the patient's maximum tolerable level during treatment. Published peer-reviewed evidence supports ESWT treatment without anesthesia, delivered with a maximum tolerable energy density, is a more effective treatment protocol than with a fixed energy density in the treatment of chronic plantar fasciitis. The established FDA protocol for EMS Swiss DolorClast® Classic calls for a starting energy setting of .09mJ/mm2 (2 Bar) gradually increasing towards .18mJ/mm2 (4 Bar). This"staircase" method for increasing energy according to patient tolerance throughout the treatment requires continued feedback from the patient during treatment and will yield maximum results.
It is essential that full contact and pressure is maintained throughout the therapy and that the "staircase" method of energy delivery is employed when performing ESWT treatment in order to maximize patient outcomes.
Shockwave Reimbursement & Compensation Guidelines
The EMS Swiss DolorClast® Classic is FDA approved for the treatment of chronic plantar fasciitis and ESWT is considered medically appropriate as an alternative to surgical therapy by many insurance companies. Practitioners should seek reimbursement for those patients who have heel spurs and/or plantar fasciitis and have failed 6 months of conservative treatment including NSAIDs, steroid injections, orthotics, weight loss, rest/elevation and physical therapy. Using CPT code
0101T, extracorporeal shock wave involving musculoskeletal system, not otherwise specified, high energy, the average national reimbursement for those insurance companies recognizing this code is $1275.00. Doctors are encouraged to check with each provider as policies among insurers will differ. Additionally, doctors utilizing the device for alternative treatment methods, which include other areas of the body, must check the corresponding CPT code as there are several.
For those physicians in areas in which insurance coverage is not available the patient will incur charges directly. Based on practice location and patient demographics recommended treatment cost will vary between $150.00 and $500.00 per session. Published data supports 2-3 sessions are required to complete the treatment therapy. Therefore, patients will pay a total of between $300.00 and $1500.00 depending on the prescribing physician. For physicians concerned with direct billing, slowly introducing this technology into your practice and gauge patient interest through constructive feedback. Both FDA approval and 12 published, peer reviewed clinical studies support this technology, making it a viable option for patients suffering from chronic foot conditions. Given this therapy is affordable and proven patients are likely to be receptive.