Medical Policy: 02.01.14 

Original Effective Date: March 2003 

Reviewed: February 2020 

Revised: February 2020 



This policy contains information which is clinical in nature. The policy is not medical advice. The information in this policy is used by Wellmark to make determinations whether medical treatment is covered under the terms of a Wellmark member's health benefit plan. Physicians and other health care providers are responsible for medical advice and treatment. If you have specific health care needs, you should consult an appropriate health care professional. If you would like to request an accessible version of this document, please contact customer service at 800-524-9242.


Benefit Application:

Benefit determinations are based on the applicable contract language in effect at the time the services were rendered. Exclusions, limitations or exceptions may apply. Benefits may vary based on contract, and individual member benefits must be verified. Wellmark determines medical necessity only if the benefit exists and no contract exclusions are applicable. This medical policy may not apply to FEP. Benefits are determined by the Federal Employee Program.


This Medical Policy document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy will be reviewed regularly and be updated as scientific and medical literature becomes available.



Low-level laser therapy, also known as cold laser therapy and sometimes called class III lasers, has been investigated as a conservative measure to treat a number of musculoskeletal disorders, soft tissue injuries including carpal tunnel syndrome (CTS) and other disorders such as Raynaud's disease and fibromyalgia. When applied to the skin, it has been hypothesized that the laser light penetrates the skin and stimulates cellular metabolism leading to temporary relief of hand and wrist pain. The exact mechanism of its effect is unknown.


The U.S. Food and Drug Administration classifies most LLLT devices as Class II devices as “lamp, non-heating, for adjunctive use in pain therapy”. Between 2002 and 2016, 44 such devices received 510(k) clearance for marketing for temporary pain relief: Including but not limited to Acculaser Pro Low Level Laser Therapy Device; Acculaser Pro4; Anodyne Therapy System, Axiom Biolaser LLLT Series-1; Axiom Biolaser LLLT Series-3; Bioptron Pro Light Therapy System and Bioptron Compact III Light Therapy System; Collagentex Rx-1; Diobeam 830; Elite Electromed L.I.T.E. 4/1; Erchonia's Allay, Emerge, EML Laser, EML Laser; Evri, Mis-Ac Derma Scanner, Pl2000, Pi5000, Pi Touch, and TH1 Laser; Excalibur IV Light Therapy System Model SGEX4-001; Excalibur Light Therapy System Model SGLEX-04-001; GRT Lite Model 8-A; Lapex 2000; Laser Helmet, Lasertouchone; Lazrpulsr 4x; Ld-I 75 And LD-I 200; LEP2000 Therapy System; Lightstream Low Level Laser; Luminex LL Laser System; Lx-100 Hair Growth Stimulation System; Medx LCS Laser Series; Microlight 830 Laser System; NMA 1052 Console System With NMA 100 Laser Accessory; Omega Excel/XP Laser System; Power Laser 90; QLaser System; Quantum Light Therapy System; Sunetics Clinical Bio-Stimulation Laser; Theralase TLC-2000 Therapeutic Medical Laser System; Thor DDII 830CL3 Laser System; Tlc-2000 Therapeutic Medical Laser System; Trilumina Therapeutic Laser System, Vectra Genisys Laser System.


Carpal Tunnel Syndrom (CTS) is perhaps the most studied application of this type of laser therapy. CTS is an entrapment neuropathy caused by compression of the median nerve as it passes from the forearm to the palm beneath the transverse carpal ligament. Associated signs and symptoms include paresthesias; numbness and tingling in the sensory distribution of the median nerve for thumb, index, middle and radial side of the ring finger; Tinel sign; Plalen sign; nocturnal awakening; and sometimes hand weakness. The etiology of CTS is unknown; however, it occurs most commonly in workers involved in repetitive hand movements. Current standard treatments include conservative measures such as wrist splints and non-steroidal antiinflammatory drugs. Surgical release of the transverse carpal ligament may be performed when symptoms fail to respond to conservative measures.


Recently the use of higher powered, also called non-surgical or referred to as HILT, lasers have been used for the treatment of the above mentioned musculoskeletal conditions, specifically peripheral neuropathy pain treatment. Sometimes these are referred to as Class IV lasers.


In November 2010, the BlueCross BlueShield Association Technology Evaluation Center (TEC) published a technology assessment of low-level laser therapy for carpal tunnel syndrome and chronic neck pain. For inclusion in the assessment studies had to: be published in a peer-reviewed journal; be randomized, sham-controlled trials and, if adjunctive therapies were used, they were applied to both groups; measure outcomes at least 2 weeks beyond the end of the treatment period; and, for neck pain studies, be studies of patients with chronic pain.


Four studies of carpal tunnel syndrome met the inclusion criteria. TEC concluded that the studies have serious limitations including limited follow-up, and no one study is so methodologically sound as to provide definitive results.


The TEC assessment included 6 trials of low-level laser therapy for chronic neck pain and found inconsistent results. The TEC assessment did comment on a systematic review and meta-analysis of randomized placebo or active-treatment controlled trials by Chow and colleagues and noted "some studied evaluated acute neck pain, some had insufficient follow-up beyond the period of treatment, one had no sham control…." Overall, TEC concluded that the studies are characterized by small sample sizes, limited statistical power, and limited long-term follow-up.


The use of infrared and/or near-infrared light and/or heat, including monochromatic infrared energy (MIRE), has not been shown to be beneficial, including symptoms such as pain arising from these conditions, of diabetic and/or non-diabetic peripheral sensory neuropathy, wounds and/or ulcers of skin and/or subcutaneous tissues.


Laser therapy or low-level laser therapy, (LLLT) has been studied for a multiple number of other conditions. There has not been successful studies that consistently demonstrates benefit of the therapy.


The American Academy of Orthopaedic Surgeons (AAOS) published clinical practice guidelines on the treatment of carpal tunnel syndrome (AAOS, 2016). In the guidelines, regarding laser treatment, it is noted that, "Limited evidence supports that laser therapy might be effective compared to placebo." (Strength of Recommendation: Limited Evidence. Limited evidence: Evidence from one or more "Low" quality studies with consistent findings or evidence from a single "Moderate" quality study for recommending for against the intervention or diagnostic or the evidence is insufficient or conflicting and does not allow a recommendation for or against the intervention.)


An evidence-based guideline for the treatment of painful diabetic neuropathy published by American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation (2011). The guideline notes LLLT is probably not effective for the treatment of this condition and is not recommended.


Prior Approval:

Not applicable



Low-level laser treatment or cold laser treatment and high-powered, non-surgical lasers are considered investigational for all applications, including but not limited to:

  • Carpal tunnel syndrome
  • Chronic neck pain
  • Chronic back pain
  • Shoulder impingement syndrome
  • Adhesive capsulitis
  • Osteoarthritis pain
  • Alopecia
  • Dental pain
  • Obesity
  • Mucositis
  • Bone regeneration/bone healing
  • Rheumatoid arthritis
  • Peripheral neuropathy
  • Wound healing, including diabetic ulcers
  • Heel pain (ie, Achilles tendinopathy, plantar fasciitis)
  • Lymphedema


The available literature on low-level laser therapy as a treatment for pain of various etiologies and in a variety of anatomical sites presents inconsistent conclusions and methodologic weaknesses including a lack of follow-up evaluation, that prevent drawing firm conclusions regarding efficacy and durability.


Procedure Codes and Billing Guidelines:

To report provider services, use appropriate CPT* codes, Modifiers, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or diagnosis codes.

  • 97039 Unlisted modality (specify type and time if constant attendance) 
  • 97139 Unlisted therapeutic procedure (specify)
  • 99199 Unlisted special service, procedure or report
  • S8948 Application of a modality (requiring constant provider attendance) to one or more areas; low level laser; each 15 minutes.
  • 0491T Ablative laser treatment, non-contact, full field and fractional ablation, open wound, per day, total treatment surface area; first 20sq cm or less
  • 0492T Ablative laser treatment, non-contact, full field and fractional ablation, open wound, per day, total treatment surface area; each additional 20 sq cm, or part thereof
  • 0552T Low-level laser therapy, dynamic photonic and dynamic thermokinetic energies, provided by a physician or other qualified health care professional


Selected References:

  • Bronco K, Naeser MA. Carpal tunnel syndrome: Clinical outcome after low-level laser acupuncture, microamps transcutaneous electrical nerve stimulation, and other alternative therapies-an open protocol study. The Journal of Alternative and Complementary Medicine1999;5(1):5-26.
  • Irvine J, Chong SL, Amirjani N, Chan KM. Double-blind randomized controlled trial of low-level laser therapy in carpal tunnel syndrome. Muscle Nerve 2004 Aug;30(2):182-7.
  • Zinman LH, Ngo M, Ng ET, Nwe KT, Gogov S, Bril V. Low-intensity laser therapy for painful symptoms of diabetic sensorimotor polyneuropathy: a controlled trial. Diabetes Care. 2004 Apr;27(4):921-4. 
  • Brosseau L, Wells G, et al. Randomized controlled trial on low level laser therapy (LLLT) in the treatment of osteoarthritis (OA) of the hand.   Lasers Surg Med. 2005 Mar;36(3):210-9.
  • Bjordal JM, Lopes-Martins RA, Iversen VV.  A randomised, placebo controlled trial of low level laser therapy for activated Achilles tendinitis with microdialysis measurement of peritendinous prostaglandin E2 concentrations.  Br J Sports Med. 2006 Jan;40(1):76-80; discussion 76-80.
  • Savigny P, Kuntze S, Watson P et al. Low back pain: early management of persistent non-specific low back pain. National Collaborating Centre for Primary Care and Royal College of General Practitioners.
  • Dincer U, Cakar E, Kiralp MZ et al. The effectiveness of conservative treatments of carpal tunnel syndrome: splinting, ultrasound, and low-level laser therapies. Photomed Laser Surg 2009 Jan 26. [Epub ahead of print].
  • Yousefi-Nooraie R, Schonstein E, Heidari K et al. Low level laser therapy for nonspecific low-back pain. Cochrane Database Syst Rev 2008; (2):CD005107.
  • Yeldan I, Cetin E, Ozdincler AR. The effectiveness of low-level laser therapy on shoulder function in subacromial impingement syndrome. Disabil Rehabil 2009; 31(11):935-40.
  • Tumilty S, Munn J, McDonough S et al. Low level laser treatment of tendinopathy: a systematic review with meta-analysis. Photomed Laser Surg 2009 Aug 26. [Epub ahead of print].
  • Chow RT, Heller GZ, Barnsley L. The effect of 300 mW, 830 nm laser on chronic neck pain: a double-blind, randomized, placebo-controlled study. Pain. 2006 Sep;124(1-2):201-10. Epub 2006 Jun 27.
  • Ay S, Dogan SK, Evcik D. Is low-level laser therapy effective in acute or chronic low back pain? Clin Rheumatol. 2010 Aug;29(8):905-10. Epub 2010 Apr 23.
  • Gur A, Sarac AJ, Cevik R et al. Efficacy of 904 nm gallium arsenide low level laser therapy in the management of chronic myofascial pain in the neck: a double-blind and randomized-controlled trial. Lasers Surg Med. 2004;35(3):229-35.
  • Altan L, Bingol U, Aykac M et al. Investigation of the effect of GaAs laser therapy on cervical myofascial pain syndrome. Rheumatol Int. 2005 Jan;2591):23-7. Epub 2003 Dec 12.
  • Konstantinovic LM, Cutovic MR, Milovanovic AN et al. Low-level laser therapy for acute neck pain with radiculopathy: a double-blind placebo-controlled randomized study. Pain Med. 2010 Aug;11(8):1169-78.
  • Fulop AM, Dhimmer S, Deluca JR et al. A meta-analysis of the efficacy of laser phototherapy on pain relief. Clin J Pain 2010 Oct;26(8):729-36.
  • Dagenais S, Tricco AC, Haldeman S. Synthesis of recommendations for the assessment and management of low back pain from recent clinical practice guidelines. Spine J. 2010 Jun;10(6):514-29.
  • Blue Cross and Blue Shield Association Technology Evaluation Center (TEC). Low-level laser therapy for carpal tunnel and chronic neck pain. TEC Assessments 2010; Volume 25, Tab 4.
  • Omar MTA, Ebid AA, El Morsy AM. Treatment of post-mastectomy lymphedema with laser therapy: double blind placebo control randomized study. J Surg Res 2011; 165(1):82-90.
  • Alfredo PP, Bjordal JM, Dreyer SH, Meneses SR, Zaguetti G, Ovanessian V, et al. Efficacy of low level laser therapy associated with exercises in knee osteoarthritis: a randomized double-blind study. Clin Rehabil. 2012 Jun;26(6):523-33.
  • American Academy of Orthopaedic Surgeons Clinical Practice Guideline on Treatment of Carpal Tunnel Syndrome. Rosemont (IL): American Academy of Orthopaedic Surgeons (AAOS); 2008. Guidelines re-issue statement September 2011. Accessed May 29, 2012.
  • Carvalho PA, Jaguar GC, Pellizzon AC, Prado JD, Lopes RN, Alves FA. Evaluation of low-level laser therapy in the prevention and treatment of radiation-induced mucositis: a double-blind randomized study in head and neck cancer patients. Oral Oncol. 2011 Dec;47(12):1176-81.
  • Petrucci A, Sgolastra F, Gatto R, Mattei A, Monaco A. Effectiveness of low-level laser therapy in temporomandibular disorders: a systematic review and meta-analysis. J Orofac Pain. 2011 Fall;25(4):298-307.
  • Savigny P, Kuntze S, Watson P, et al. Low back pain: early management of persistent non-specific low back pain. National Collaborating Centre for Primary Care and Royal College of General Practitioners. 2009; Low back pain in adults: early management
  • Lalla RV, Bowen J, Barasch A, et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. May 15 2014;120(10):1453-1461. PMID 24615748
  • Chang WD, Lee CL, Lin HY, et al. A Meta-analysis of Clinical Effects of Low-level Laser Therapy on Temporomandibular Joint Pain. J Phys Ther Sci. Aug 2014;26(8):1297-1300. PMID 25202201
  • Tchanque-Fossuo CN, Ho D, Dahle SE, et al. A systematic review of low-level light therapy for treatment of diabetic foot ulcer. Wound Repair Regen. 2016 Jan 7 [Epub ahead of print].
  • Peters S, Page MJ, Coppieters MW, et al. Rehabilitation following carpal tunnel release. Cochrane Database Syst Rev. 2016;2:CD004158.
  • American Academy of Orthopaedic Surgeons (AAOS). Management of Carpal Tunnel Syndrome Evidence-Based Clinical Practice Guideline. Published February 29, 2016. Accessed June 1, 2017.
  • National Institute for Health and Care Excellence (NICE). Low back pain and sciatica in over 16s: assessment and management [NG59]. 2016  
  • ECRI Institute. High-power Laser Therapy for Chronic Pain. Plymouth Meeting (PA): ECRI Institute; 2018 Aug 15. (Custom Rapid Review).
  • Wyszynska, J, and Bal-Bochenska, M. Efficacy of High-Intensity Laser Therapy in Treating Knee Osteoarthritis: A First Systematic Review. Photomed Laser Surg. 2018;36(7):343-353. PubMed 29688827
  • Choi HW, Lee J, Lee S, Choi J, Lee K, Kim BK, Kim GJ. Effects of high intensity laser therapy on pain and function of patients with chronic back pain. J Phys Ther Sci. 2017 Jun;29(6):1079-1081.
  • Bekhet AH, Ragab B, Abushouk AI, Elgebaly A, Ali OI. Efficacy of low-level laser therapy in carpal tunnel syndrome management: a systematic review and meta-analysis. Lasers Med Sci. 2017 Aug;32(6):1439-1448
  • Skelly AC, Chou R, Dettori JR,et al. Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review. Comparative Effectiveness Review No. 209. AHRQ Publication No 18-EHC013-EF. Rockville, MD: Agency for Healthcare Research and Quality; June 2018.
  • Liu KH, Liu D, Chen YT, Chin SY. Comparative effectiveness of low-level laser therapy for adult androgenic alopecia: A system review and meta-analysis of randomized controlled trials. Lasers Med Sci. 2019;34(6):1063-1069.


Policy History:

  • February 2020 - Annual Review, Policy Revised
  • February 2019 - Annual Review, Policy Revised
  • February 2018 - Annual Review, Policy Revised
  • February 2017 - Annual Review, Policy Revised
  • February 2016 - Annual Review, Policy Renewed
  • December 2015 - Interim Review, Policy Revised
  • March 2015 - Annual Review, Policy Revised
  • April 2014 - Annual Review, Policy Renewed
  • June 2013 - Annual Review, Policy Renewed
  • July 2012 - Annual Review, Policy Renewed
  • August 2011 - Annual Review, Policy Renewed

Wellmark medical policies address the complex issue of technology assessment of new and emerging treatments, devices, drugs, etc.   They are developed to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Wellmark medical policies contain only a partial, general description of plan or program benefits and do not constitute a contract. Wellmark does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Wellmark or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. Our medical policies may be updated and therefore are subject to change without notice.


*CPT® is a registered trademark of the American Medical Association.