On June 24, the FSS announced the new dispute resolution standards for extracorporeal shock wave therapy, which will be implemented in its dispute resolution practices beginning next month. This therapy is widely used alongside manual therapy for treating musculoskeletal disorders and is considered a non-covered medical service.
This initiative aims to prevent a potential 'balloon effect' where patients shift from manual therapy to extracorporeal shock wave therapy as management benefits for manual therapy are introduced. Concerns have been raised that if medical institutions recommend extracorporeal shock wave therapy instead of manual therapy, it could lead to over-treatment and excessive claims on actual expense insurance.
The areas eligible for treatment include the shoulder joint, elbow joint, hip joint, knee, ankle joint, foot, and spine. The treatment limit is set at 12 sessions per year, with a maximum of six sessions per area and one session per week. The same area will have a total limit of six sessions, regardless of whether it is treated on both sides or the specific condition.
If multiple areas are treated simultaneously on the same day, only the cost for one area will be reimbursed. This measure is intended to prevent patients from circumventing the session limits through simultaneous treatments.
However, in special cases where patients suffer from multiple complex conditions due to severe illness, the necessity for treatment may be reviewed even if it exceeds the established criteria. Conversely, patients who repeatedly receive treatment at long-term care hospitals or traditional medicine clinics solely based on their severe illness status may be excluded from additional reviews.
The FSS plans to apply these guidelines specifically to disputes related to extracorporeal shock wave therapy.
* This article has been translated by AI.
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