Summary & Overview
CPT 0102T: Shock Wave Treatment of Lateral Humeral Epicondyle Under Anesthesia
CPT code 0102T represents a shock wave treatment procedure applied to the lateral humeral epicondyle, performed under anesthesia other than local anesthetic. This code is classified as a Category III CPT code, signifying its use for emerging medical technologies and procedures that are not yet widely adopted or fully established in clinical practice. The procedure is typically conducted in an ambulatory surgical center, highlighting its outpatient setting and the requirement for advanced anesthesia services.
Nationally, this code is relevant for providers specializing in pain medicine, physical medicine and rehabilitation, and orthopaedic surgery of the spine. The publication covers key payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, providing insight into payer coverage and policy considerations for this procedure.
Readers will gain an understanding of the clinical context for 0102T, including its role in treating musculoskeletal conditions such as intervertebral disc displacement, low back pain, and sciatica. The summary also addresses related billing codes, common modifiers, and associated provider taxonomies. This resource offers benchmarks and policy updates to inform stakeholders about the evolving landscape of shock wave treatments in outpatient settings.
CPT Code Overview
CPT code 0102T describes the application of shock wave treatment to the lateral humeral epicondyle in an anesthetized patient. This procedure is performed under anesthesia other than a local anesthetic, indicating a higher level of intervention and patient management. As a Category III code, 0102T is used for emerging technologies, services, and procedures that require further clinical evidence and assessment. The typical site of service for this procedure is an Ambulatory Surgical Center (Place of Service 24), reflecting its outpatient nature and the need for specialized equipment and anesthesia support.
Clinical & Coding Specifications
Clinical Context
A patient presents with chronic lateral epicondylitis (commonly known as tennis elbow) that has not responded to conservative treatments such as physical therapy, medications, or local injections. The physician determines that shock wave therapy may be beneficial. Due to the intensity of the procedure, anesthesia other than a local anesthetic is required. The patient is scheduled for the procedure at an ambulatory surgical center. The workflow includes pre-procedure assessment, administration of anesthesia, application of shock wave treatment to the lateral humeral epicondyle, and post-procedure monitoring. The procedure is typically performed by a pain medicine physician, physical medicine & rehabilitation physician, or an orthopaedic surgery of the spine physician.
Coding Specifications
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Modifier
50(Bilateral Procedure): Used when the shock wave treatment is applied to both lateral humeral epicondyles during the same session. -
Modifier
51(Multiple Procedures): Used when the shock wave treatment is performed in conjunction with other procedures during the same operative session.
| Provider Taxonomy Code | Specialty |
|---|---|
208VP0000X | Pain Medicine Physician |
207LP2900X | Physical Medicine & Rehabilitation Physician |
207XS0117X | Orthopaedic Surgery of the Spine Physician |
Related Diagnoses
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M51.26- Other intervertebral disc displacement, lumbar region- Indicates lumbar disc displacement, which may cause pain and be considered for shock wave therapy if conservative treatments fail.
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M54.5- Low back pain- Represents general low back pain, a common indication for interventional pain procedures including shock wave therapy.
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M51.36- Other intervertebral disc degeneration, lumbar region- Refers to degenerative changes in lumbar discs, often associated with chronic pain and considered for advanced therapies.
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M54.16- Radiculopathy, lumbar region- Describes nerve root pain in the lumbar region, which may be addressed with shock wave therapy or other interventional procedures.
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M54.30- Sciatica, unspecified side- Indicates sciatic nerve pain, a frequent reason for pain management interventions such as shock wave therapy.
Related CPT Codes
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62287- Aspiration or decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc- May be performed for patients with disc-related pain, often as an alternative or adjunct to shock wave therapy.
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77002- Fluoroscopic guidance for needle placement- Used to guide needle placement during interventional procedures, potentially in conjunction with shock wave therapy if precise targeting is needed.
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64483- Injection(s), anesthetic agent and/or steroid, transforaminal epidural- Commonly used for pain management in patients with lumbar spine conditions; may be performed alongside or instead of shock wave therapy.
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64635- Destruction by neurolytic agent, paravertebral facet joint nerve- Used for pain relief in patients with facet joint pain; can be an alternative or additional procedure in the clinical workflow.
National Reimbursement Benchmarks
National mean rates for CPT code 0102T show that Blue Cross Blue Shield has the highest average reimbursement at $636.99, while Aetna is the lowest among major commercial payers at $302.34. The BUCA (average commercial) mean rate stands at $468.65, which is substantially higher than typical Medicare rates for similar codes, though Medicare-specific data is not available in the input.
Rate dispersion varies significantly across payers. Aetna exhibits the tightest range between the 25th and 75th percentiles ($138.00), indicating less variability in contracted rates. In contrast, Blue Cross Blue Shield has the widest spread ($321.00), reflecting greater variability in reimbursement. Cigna, UnitedHealth Group, and BUCA also show moderate dispersion, with ranges of $256.00, $269.00, and $219.00, respectively.
The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.
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