What Are The Specific Cpt Codes That Massage Therapists Can Use
These are some of the CPT codes commonly used by massage therapists some are used more commonly than others.
- CPT Code 97124 Massage Therapy
- CPT Code 97140 Manual Therapy
- CPT Code 97112 Neuromuscular Re-education
- CPT Codes 97010 Hot/Cold Packs
- CPT Codes 97110 Therapeutic Exercise
Keep in mind that these codes are updated periodicallyadding, deleting and/or refining codes and descriptors. Staying up to date with new codes can help facilitate claims processing and reimbursement.
What Does Manual Treatment Entail
Manual therapy, also known as manipulative therapy, is a type of physical therapy that involves kneading and manipulating muscles, as well as joint mobilization and manipulation. It is primarily used by physical therapists, physiotherapists, and occupational therapists to treat musculoskeletal pain and disability.
Massage Therapy Coding Tips:
- Only use one of these codes on a bill 97140 or 97124. Dont use both.
- 97010 hot/cold packs is now mostly bundled with 97124 or 97140 meaning you might not be able to bill a separate fee for this service.
- If you are paid for using an improper code, it doesnt necessarily mean it is acceptable. You are responsible for billing the proper codes.
- Questionable codes are: 97110, 97112, 97530, 97001-97006 . Once in awhile you may find a company that will pay for those. It is still not clear whether a massage therapist is able to use those codes.
- Codes are not restricted to one group of providers. Some try to say that the codes listed above are physical therapy codes. Any procedure code may be used by a qualified provider.
- Know your codes. Know your billing procedures.
- You have to know more than just the codes you need to know how to use them and how to bill to get paid by insurance. To learn more about billing see my book : Massage Insurance Billing: Healthcare Integration and Advocacy. It is important for more massage therapists to start billing insurance for medically based treatments. We currently need more people involved so they know what is happening and who will start taking a stand to get massage therapy the recognition and respect that it deserves.
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Cpt Codes For Massage Therapy
Once youâve verified that massage therapy coverage is possible, the two main billing CPT codes identified for insurance billing of massage therapy include:
- 97124: Stroking, compression, percussion
- 97140: Manipulation, traction, lymphatic drainage
Code 97124 is more so directed at massage therapy, while 97140 is actually for manual therapy. When billing for either of these two codes, be sure to cite these exact treatment procedures in your claim to ensure coverage. Additionally, do not cite both of these codes when submitting for reimbursement. Insurance companies will not cover services if both of these codes are cited.
Be sure to also have your clientâs insurance information & photocopies of their card on file, as well as their chart notes for each session readily available. These will be essential when filling out your CMS-1500 forms for each reimbursement.
What Is The Meaning Of Cpt Code 97162
97162 Physical therapy evaluation : Moderate difficulty, including the following elements: A history of the current condition, together with 1-2 personal variables and/or comorbidities that affect the treatment approach. An evaluation of the bodys systems using standardized tests and metrics to treat three or more issues.
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Cpt Code : Code Description
Massage therapy CPT code 97124 code description is as follows:
The therapeutic procedure, one or more areas, each 15 minutes massage, including effleurage, petrissage, and/or tapotement .
Massage therapy CPT code is a time-based code or service, i.e., this code is reported in units of 15 minutes.
This therapy is a therapeutic procedure therefore, it requires a direct interaction between the physician and the patient. A therapeutic procedure is effecting change via clinical skills or services in an attempt to improve the functionality. These procedures should be performed by a physician or a therapist appropriately licensed to do so. Massage therapy includes the following specific techniques:
- Effleurage: massage technique involving circular motions
- Petrissage: massage technique involving squeezing to alleviate the muscle spasm.
- And/or tapotement
According to AAPC:
A massage expert or a therapist performs various types of stroking and other massages on a patients body for therapeutic purposes. Massage therapy aims to increase or restore blood circulation and relax the muscles. The therapy technique comprises different styles, light, and firm pressure using hands, palms, fingers, and thumbs.
How Can A Massage Therapist Bill The Insurance
A massage therapist can bill the medical insurance, as long as
- The therapy service is the necessary part of the treatment plan prescribed by a chiropractor, DO, or MO,
- The therapist is licensed
- The therapist has an NPI number. If as a therapist, you lack a valid NPI number, you can apply to get one here.
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Other Covered Providers Of Physical Medicine Services
- Medical or osteopathic physicians who are board qualified or board certified in physical medicine and rehabilitation.
- For attending providers, special payment policies may apply. These policies apply when these providers are not board qualified or certified in physical medicine and rehabilitation. See the Physical Medicine chapter in our payment policies section.
L& I will not pay for services provided by exercise physiologists, kinesiologists, aides and other unlicensed personnel.
How Do You Bill For Massage Therapy
Just as with conventional medicine, holistic practices must bill insurance companies to receive reimbursements for their services using CPT codes. These Current Procedural Terminology codes, or CPT codes, are used by insurance providers to document most medical procedures performed by healthcare providers across all specialties. These CPT codes characterize the type of procedure being done so healthcare providers can bill insurance companies for the right services and procedures.
Like other holistic practices, there are unique CPT codes for massage therapy treatments that are specific to the specialty. For a massage therapist to receive quick and reliable payments from the insurance company, insurance coding and billing must be completed accurately. Errors can result in lengthy delays to the reimbursement process or even denials.
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Do Insurance Cover Massage Therapy
Does your health insurance cover massage therapy? This article discusses what progress has been made as far as massage therapy insurance reimbursement and if and when sessions may be covered as well as regional.
How To Get Medical Insurance To Cover Massage Therapy Massage Therapy Medical Insurance Medical Massage
What If Your Massage Isnt Covered
If your massage therapy isnt covered by your insurance, consider these options to help you find and receive affordable services:
- If you have a health savings account , you may be able to use it to cover massage costs if it qualifies as medically necessary. Learn more about HSAs and flexible spending accounts .
- Contact local massage schools to see whether they offer massages at a discount.
- Ask for discounts where you get your massage services.
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Tips For Cpt Code 97124 Massage Therapy:
Correct medical billing and coding for massage therapy improve the revenue cycle and reimbursements of the healthcare practice. Several factors are to be considered when billing the CPT code massage therapy.
Manual therapy and massage therapy are linked codes. It means if these therapies are billed, only one of them is reimbursed even though both services were performed. For this particular scenario, modifier 59 should be used. Following are some of the factors to be considered:
How Do You Make An Insurance Claim
State laws and individual insurance plan policies control whether massage therapists can bill for their services. Massage therapists should fully understand the scope of practice in their state to make sure they are billing health insurance only for services within the state scope of practice law. As mentioned above, it is critical that you ensure that massage therapy services, provided by a state licensed massage therapist, is a covered benefit in your client’s insurance plan.
Health insurance claims are legal documents, so massage therapists must collect and retain information supporting their requests for payments. Typically, a claim file must have documentation to confirm that the service was providedat a minimum. Insurance companies also usually require a doctors order for a service before they will pay a claim, so make sure you are familiar with the requirements of the insurance companies they work with.
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Does Insurance Cover Couples Counseling
If youre planning on using insurance to pay for couples counseling, the rule requiring a mental health diagnosis will continue to apply and require that one partner receive a mental health disorder diagnosis. Some people feel this has the potential to skew their therapeutic experience.
As with any diagnosis you receive, a mental health disorder diagnosis may remain in your permanent record. In some instances, it may be accessed by background checking systems for your entire life.
Since insurers offer an array of plans, its not possible to give the specifics of each plan they cover. Here are some examples of coverage you may be able to get for therapy from specific insurers:
Confirm Your Patients Insurance Eligibility
A common problem with insurance billing is when claims are denied or delayed due to ineligible insurance coverage of established patients. Whether or not the patient declined to alert their healthcare provider about the insurance change or if the provider failed to update patient records, the result can be delayed payments. Confirming your patients insurance eligibility before their first visit can prevent issues with insurance companies.
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How Do Massage Therapists Find Out If Their Clients Have Coverage For Massage Therapy Services
Be sure to discuss rates and payment expectations with your client during your initial phone contact. Getting things in order before their initial visit makes good sense in order to avoid time-consuming issues later on. Be sure to ask your client to find out whether massage therapy is a coverable service under their specific insurance and plan. If it is, they may want to check if massage is coverable by a . Some plans require that massage be performed by a physical therapist, occupational therapist, chiropractor or other. Just because an insurance company offers massage as a plan benefit does not necessarily mean they allow massage therapists to provide the service.
In some cases of auto accident and workers comp, it may also be necessary to be in regular contact with a case manager regarding your services as they may be assigned to oversee the care of their insured.
Why Massage Therapy Is Important
Health care options such as massage therapy have proved to be a viable and beneficial form of treatment for individuals with a variety of health ailments. More and more doctors are prescribing massage therapy to individuals with injuries, illnesses and chronic health conditions.
Massage therapy treatment from a registered massage therapist can treat health conditions such as back and neck pain, sports injuries, headaches, whiplash and many other common issues. It is also an effective form of treatment for other conditions, such as anxiety, depression, stress and even some diseases, such as cancer, stroke and arthritis. Massage therapy can be beneficial at any age.
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Timed Vs Untimed Massage Therapy Cpt Codes
For rehabilitation providers that bill Medicare, there are two different types of massage therapy billing codes: untimed and timed codes. When using untimed codes, the massage therapist is paid a predetermined fee, no matter the time spent on treatment. These codes can be billed once per treatment session. Timed codes are reimbursed based on the time spent working 1:1 with their patient, and include only skilled interventions. Timed codes can be billed multiple times per session, whereas untimed codes can only be billed once per session.
Technically, each timed code represents 15 minutes of treatment. However, because treatment may not always be split into perfect 15 minute segments, the 8-Minute Rule was devised. In order to bill one unit of time for a code, the provider must spend at least 8 minutes performing the service. To calculate the number of units to bill for timed codes, add up the total minutes spent and divide by 15. This will give you the number of units you can bill. If the remainder is more than 8, you can bill an additional unit if it’s 7 or under, you must bill for the minimum units.
An 8-Minute Rule table is provided here:
8-22 minutes: 1 Unit
38-52 minutes: 3 Units
53-67 minutes: 4 Units
If you need help organizing past sessions per these rules, or billing clients for treatments, Healthieâs Free Starter Plan makes it easy and streamlines future client scheduling and payment processing. Simply click here to get started today.
Massage Discounts Offered Through Healthcare Plans
There is a variety of insurance providers that offer their clients discounts for massage therapy.
The American Massage Therapy Association provided a guide on how you can use these discounts.
Usually, companies contract with specific massage therapists.
In most cases, it should be therapists that work in clinical settings and services must be covered liability insurance.
In other words, the healthcare sphere markets massage therapists services.
As you can see an insurance plan may offer massage therapy in the form of reimbursement or as discounts.
For example, according to Kaiser Permanente, most plans include massage therapy only in those cases when it is determined as medically necessary.
There is an opportunity to apply for the Complementary Choices Discount Plan that covers services out of the reimbursement requirements or those out of the allowed number of visits.
Also, Kaiser Permanente claims that all listed massage therapy providers meet the requirements of the organization as well as the state licensing board.
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Codes : Massage Therapy Vs Manual Therapy Cpt Codes
In our continuing series on CPT codes, we will take a look at massage therapy and its close relationship with manual therapy in terms of procedure and billing code. These two therapies are often indistinguishable when viewed in practice, and each commonly experience billing errors when billed at similar times.
Learn more about these two therapies, their differences, goals, and billing nuance.
Cpt Code 97124 Modifiers
The purpose of CPT code modifications is to make the action and goal of the therapist clear. For example, if the therapist invoices 97140 for both appointments with the same ICD code, it will appear to be duplicate billing.
Therefore, code the first session 97140-59 to explain why there is an apparent discrepancy between these two sessions.
Two comparable treatments were conducted on the same person in a single day or over a few days, as the -59 modifier suggests. You may get into trouble with your insurance company if you utilize the -59 modification.
When a patient receives chiropractic manipulative treatment in a spinal region defined by CPT codes 97112 and CPT code 97124, the Correct Coding Initiative Edits state that these procedures are not independently reportable .
Physical medicine and rehabilitation codes can be reported using modifier 59 or XS if these physical medicine and rehabilitation therapies are performed in a separate location from CMT.
However, the modifier XS is more technically true or exact than the modifier 59 since it suggests that the service is separate and distinct from manipulation.
The 59 or XS should only be used for massage and manual treatment during a CMT appointment. Claims denials and payment delays can occur due to billing using incorrect chiropractic CPT codes, which can significantly influence your ability to make money and remain in business.
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Common Massage Therapy Cpt Codes And Modifiers
At the current time, there is no standard coverage for massage therapy services within large insurance providers. This means getting coverage comes down to the reason for care and how that care is defined to the insurance company, which requires the usage of a correct and specific massage CPT code. You can read more about verifying insurance coverage for massage therapists here.
Once youâve verified that massage therapy coverage is possible, the main billing CPT billing codes for massage therapy include:
- CPT Code 97010: Hot & cold packs
- CPT Code 97124 Therapeutic Procedure, 15 minutes: Stroking, compression, percussion
- CPT Code 97140 Therapeutic Procedure, 15 minutes: Manipulation, traction, lymphatic drainage
CPT code 97124 is more so directed at massage therapy, while 97140 is actually for manual therapy. When using either of these massage therapy billing codes, be sure to cite these exact treatment procedures in your claim to ensure coverage. Additionally, do not cite both of these codes when submitting for reimbursement without modifier code 59, discussed below. Insurance companies will not cover services if both of these massage therapy CPT codes are cited.
Everything You Need To Bill Insurance
Before you can bill insurance for massage therapy, you need all of the following:
- License to practice massage therapy
- National Provider Identifier If you dont have an NPI, you can get one here.
- Rx for treatment
Gather all of this before you begin the massage billing process. Keep accurate SOAP Notes. You may be required to submit additional treatment information. Here are some examples of SOAP Notes for massage therapy.
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What Are The Most Common Cpt Codes For Massage Therapy
The bulk of the services a licensed massage therapist bills to insurance will likely fall under the following codes:
- 97010 Hot and Cold Pack Therapy
- 97124 Massage Therapy : Therapeutic Procedure, 15 minutes one or more areas, including effleurage, petrissage, and tapotement, compression, percussion
- 97140 Manual Therapy : Therapeutic Procedure, 15 minutes mobilization, manipulation, manual lymphatic drainage, manual traction, one or more regions
- Massage and manual therapies are broken down into 15-minute increments. Mixing and matching these codes can get your claim, or part of your claim rejected depending on the insurance company and the state. Therefore, we recommend you stick with one therapy per visit.
Here is an example of how to use the code for a 60-minute visit to massage therapy:
Use code 97010 one time per day. If a chiropractor, physical therapist, or doctor has already used this code, then you cannot, for this reason, we recommend you have your appointments set on different days from other providers.