Every physician, Nurse Practitioner & Physician Assistant learned about the ANS (sympathetics & parasympathetics) in medical school.    Many have forgotten much of what they learned - yet almost everything in the human body is controlled by or affected by the ANS.   Consequently, the ANS testing allows the practitioner to address the CAUSE of the problems instead of treating the symptoms only.

For the office manager or biller - the testing of the ANS appears to be not only interesting - but also EXTREMELY profitable, due to the advent and changes in the ANS testing industry.   At the same time, though, you have to be careful as some Medicare localities will pay for ONE ANS testing device, while they may not pay for SEVERAL of the others.  Not all ANS testing devices are equal in the eyes of Medicare, Blue Cross Blue Shield or others.

You also need to be very careful when you get billing codes and billing advice from the salesperson whose sole income depends on you buying their product.  There will be some that will tell you to bill 95921 plus 95922, 93923 plus 95923, plus 95943, etc.     If you listened to them, you would believe that a simple 11 minute test will result in $800 or more income - which is NOT true.   The true Medicare allowed amount - if you are following our billing advice - the average is closer to $317  and there are only 3 codes that we suggest you use if you buy a TM-FLOW device from us.  Only 3 - but those 3 have a Medicare allowed of $280 in Oklahoma up to $370 in Alaska.    

You also need to be careful as some Medicare and BCBS carriers may require you to use one of the 24 covered diagnosis codes in order to be paid - so when the salesperson gives you a list of 150 codes and says "Medicare should pay", challenge them.  Better yet - just contact us, as we have the Medicare LCDs (Local Coverage Determinations) for every locality and we update them daily!

So - what is the TM-FLOW test?  

It is a machine that use electrodes on the patient's feet, blood pressure cuff, o2 Sensor and takes about 11 minutes to test the patient.  It tests 3 different areas:

1.   ANS by testing the sympathetics and parasympathetics

2.   Sudomotor function with electrodes on the feet

3.   ABI (basic only) with the use of plesthsmography

It is non invasive, non painful and can be done on any patient in the office that is able to stand up on their own towards the end of the test.   The patient is first tested laying flat and then at one point, you'll help the patient stand up for 2 minutes.   It is so simple that a monkee (literally) could be taught how to do this test and does not require a nurse, registered technician or licensed provider to hook up the patient and push the button.  It's really that simple.   Don has been teaching physicians, nurses and MAs how to do ANS testing since 1999 and it is amazing how this technology helps the patients and the practice income.  

Here is a short 2 minute video on why the ANS, Sudomotor and ABI is so important.  Because the video size is large (21 mb), I uploaded it into my Sharefile folder so you can either watch it or download it (in case you have slow internet speed - it's better to download than stream).


So, let's talk a bit about the money side.  

"I understand that Don is creating a video for providers about how this helps save lives, improve lives and detect problems earlier - but let's see the codes and money".

As I said earlier, you have 3 CPT codes that  you can bill (if all 3 are medically indicated) when doing the TM Flow from LD Technology with the average Medicare allowed for 2018 shown below:  

​95921:      $   87

​95923:      $ 137

93922:      $   93

average    $ 317

Again, this number may be higher or lower depending on where you are.  If you're in San Francisco, Hawaii or New York city where you have to pay $zillions for monthly rent or you have to pay for parking at your grocery store - it's going to be more.  If you're in Oklahoma or Mississippi or Nebraska, Texas or Louisiana - it will be less.

Typically, 2 1/2 tests a month pays for the equipment and your consumable cost is about $2.75 per test (2 electrodes).   So - if you are doing 2 tests per day, this gives you about $13,827 a month net profit after paying the lease on the device and the consumable cost.  2 a day takes you about 2/10 of a year to pay it off and your Return On Investment averages about 475% annually.  In fact, with most clients, I can get it set up on a lease plan that allows you to pay it off with just the first 3 months payments and the first payment is not even due until the end of the 3rd month.  That means that when the first payment becomes due - you pay it off in full with the money you made from it the first 3 months.   Then - you're looking at almost total profit.  That's much better than mutual funds of 7% or a 1 year Certificate of Deposit which is about 2%.   Then, you need to figure out what to do with the extra $165,924 a year income (maybe a raise for the employees?)

If you're doing 4 a day, your net just jumped to $28K a month or $341K a year.

Give us a call at 903 871-1172 and let me show you what ICD-10 codes YOUR Medicare or commercial carriers will pay for and help you run a proforma.  There is no charge and no obligation.  You might be surprised!

Don't forget that medical necessity is required for any carrier to pay for any tests or procedures.  This website is also not a guarantee that any carrier will pay for the services 100% of the time as you need to make sure you're following the NCDs, LCDs and carrier policies as well as demonstrating medical necessity.

25 minute video on Clinical Applications of ANS


25 Minute video teaching clinical applications for ANS testing.   This is a live recording of a training Don did with a cardio group practice in 2017

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