Only bill insurance companies that will reimburse a massage therapist. Stay within your scope of practice. Use the correct form and be sure to fill it out correctly. Use the proper, most current codes. When applicable, bill in 15 minute increments. Confirm a procedure code is accepted by a company prior to submission.
Full Answer
What is the billing code for a massage therapist?
Insurance Billing 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 (Hydro Therapy) 97124 Massage Therapy (Basic Swedish Massage)
How do I Bill my insurance company as a massage therapist?
Only bill insurance companies that will reimburse a massage therapist. Stay within your scope of practice. Use the correct form and be sure to fill it out correctly. Use the proper, most current codes. When applicable, bill in 15 minute increments. Confirm a procedure code is accepted by a company prior to submission.
Can you use 97124 and 97140 codes for massage therapy?
Additionally, do not use codes 97124 and 97140 to bill for massage work during the same session. The Correct Coding Initiative of Medicare has determined that there is not enough difference between these two codes to allow claim of their use in the same therapy session.
How do I know if my massage is covered by insurance?
The easiest and most reliable way to check this is directly with the insurance company to be billed. Additionally, do not use codes 97124 and 97140 to bill for massage work during the same session.
How do you bill for massage therapy?
The CPT code for massage is 97124 which is a timed-based service which is reported in 15 minute increments. There is only one code for all massage (97124) so longer massage services would simply be reported using the proper number of units (e.g., 60 minutes = 4 units).
Does Medicare pay for Therapeutic massage?
Medicare doesn't cover massage therapy. You pay 100% for non-covered services, including massage therapy.
What is the difference between 97140 and 97124?
97124: Therapeutic procedure, one or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion). 97140: Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes.
What CPT codes can a massage therapist use?
The CPT codes massage therapists can use without question are: 97010 - hot and cold packs; 97124 - massage; and 97140 - manual therapy.
Does Medicare cover CPT code 97124?
Services that do not meet the requirements for covered therapy services in Medicare manuals are not payable using codes and descriptions as therapy services.
Does Medicare pay for chiropractic massage?
Medicare doesn't cover other services or tests a chiropractor orders, including X-rays, massage therapy, and acupuncture (unless the acupuncture is for the treatment of chronic low back pain).
Can massage therapist perform 97140?
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.
Can 97110 and 97140 be billed together?
Can CPT Code 97110 And 97140 Be Billed Together? Yes, they can be billed together. CPT 97110 and CPT 97140 can be performed on same day for same patient; instead, it is very common practice to use these codes together on same day.
Can CPT code 97124 and 97140 be billed together?
It's important to note that you can never bill 96523 or 97124 with 97140, because these codes represent mutually exclusive procedures.
Can 97012 and 97140 be billed together?
when I looked these up I get: 97012 is a manual traction code and 97140 is a manual therapy code. They consider these to be two modalities that are not possible for the same area in the same session. That is the mutually exclusive part.
Who can bill CPT 97140?
American Medical Association (AMA) coding guidelines dictate that it is only appropriate to bill for Chiropractic Manipulative Treatment (CMT) and manual therapy (CPT code 97140) for the same patient on the same visit under certain circumstances.
What is the ICD 10 code for massage therapy?
ICD-10-PCS Code 8E0KX1Z - Therapeutic Massage - Codify by AAPC.
Does Medicare cover massage for arthritis?
They're approved by Medicare, and they cover everything original Medicare does. However, these plans often extend coverage to other areas of treatment, including vision and dental care. As of 2019, therapeutic massage is covered as a supplemental benefit under some Medicare Advantage plans.
Does Medicare cover therapy?
Medicare Part B covers mental health services you get as an outpatient, such as through a clinic or therapist's office. Medicare covers counseling services, including diagnostic assessments including, but not necessarily limited to: Psychiatric evaluation and diagnostic tests. Individual therapy.
Does insurance pay for arthritis massage?
If your physician gives you a prescription for massage therapy as a treatment your insurance may cover treatment. Specifically, if you are being covered under workers compensation due to an injury you may be eligible for insurance covered massage.
Does Medicare cover lymphatic drainage?
Under current Medicare policy, lymphedema patients have coverage for Manual Lymphatic Drainage (MLD), performed by a qualified Medicare provider such as a physical or occupational therapist, and, when certain conditions are satisfied, a pneumatic compression pump.
How Does Medicare Cover Massage Therapy?
As such, if you receive therapeutic massage services from a massage therapist in the hospital or in an outpatient setting, you will be responsible for 100% of the costs.
Do Medicare Advantage Plans Cover Massage Therapy?
Even though Medicare Advantage is offered by private insurance companies, these insurers still must provide all the same benefits as Original Medicare at a minimum. In many cases, they offer extra benefits to their members.
Why Does Accurate Massage Therapy Insurance Billing Matter?
Accurate billing is the result of using appropriate codes and filing claims in a timely manner, which means you’ll get reimbursed by insurance companies promptly and your revenue cycle doesn’t get too interrupted. Overall, accurate insurance billing can impact your practice’s financial standing!
What insurances cover massage therapy?
At present Medicare does not pay for massage treatments, but in general, there are three main sources of insurance billing for massage therapy, these may vary from state to state: 1 Major medical plans (Blue Cross, Blue Shield, United, Aetna, Cigna, etc.) 2 Personal Injury (PIP) 3 Workers Compensation Insurance (Workers Comp)
What does CPT stand for in massage therapy?
Most Frequently Asked Questions About Massage Therapy CPT Codes. CPT stands for Current Procedural Terminology (CPT). The American Medical Association (AMA) manages the oversight of the codes that give definition and structure to the procedures and services performed by physicians and health care providers across the country.
Why use modifiers in massage therapy?
Using modifiers to justify increased fees to insurance companies is a misuse of those codes and damages the relationship between massage therapists, the medical community, and insurance companies.
What is the code for neuromuscular therapy?
Their use implies that the user is a physical therapist. 97112 is not the code for neuromuscular therapy; use 97140 instead.
Why is my insurance billing delayed?
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 patient’s insurance eligibility before their first visit can prevent issues with insurance companies. In our opinion, correct verifications have the most direct correlation with successfully getting claims paid.
How to verify insurance for massage?
When you bill insurance for medical massage services, you will need to verify your patient‘s insurance benefits directly with the payer before you start treatments. You can do this by contacting the insurance company via the phone number listed on the patient’s medical card and providing the patient’s policy information along with their date of birth.
What is massage therapy?
Massage therapy is a therapeutic practice that involves working on the tissues throughout the body. There are a variety of different techniques that can be used for massage, and each carries its own benefits. This type of therapy can be very beneficial for relieving muscle pain, preventing migraines and headaches, eliminating muscle compensations, ...
What are the benefits of massage?
Some of these can include alleviating muscle and joint pain, promoting flexibility, and reducing swelling following an injury or surgical procedure.
How does massage help with scar tissue?
Some techniques are designed to promote total body relaxation, others target specific muscles and problem spots related to sports injuries, and some massage techniques attempt to promote healing by breaking up scar tissue and restoring tissue function. Regardless of the specific technique used, massage therapy has been shown to have a wide range ...
Why is massage important?
Because it is used all over the world, many different techniques have arisen to address certain types of issues.
Is massage therapy covered by Medicare?
For the majority of Medicare recipients, massage therapy is not covered by Medicare. Medicare Part A and Part B require that all covered services are medically necessary, and they generally do not find massage therapy to fit in that category because it is considered an alternative treatment.
Is massage therapy good for back pain?
This can make massage therapy a highly beneficial treatment option for a variety of diseases and conditions. Some of these can include carpal tunnel, lower back pain, arthritis, cancer-related pain, migraine, edema, and more. In addition to physical benefits, massage therapy can carry a number of mental and emotional benefits as well.
How to bill insurance for massage therapy?
Interacting with insurance companies correctly will pay off. The following hints will help any massage therapist realize that billing insurance isn’t very hard: 1 Documentation assures payment – make certain your SOAP notes accurately reflect what occurred, chart progress and cover what you billed for. 2 Always follow the doctor’s prescription. 3 Only bill insurance companies that will reimburse a massage therapist. 4 Stay within your scope of practice. 5 Use the correct form and be sure to fill it out correctly. 6 Use the proper, most current codes. 7 When applicable, bill in 15 minute increments. 8 Confirm a procedure code is accepted by a company prior to submission.
What is CPT code?
Combined with the World Health Association’s International Classification of Disease (ICD) codes, the Current Procedural Terminology (CPT) codes offer a concise and accurate description of the medical professional’s actions.
How many minute increments are there in a bill?
When applicable, bill in 15 minute increments.
Does insurance cover massage therapy?
As scientific research continues to prove the value of massage therapy, an increasing number of insurance companies now cover massage therapy as an acceptable and billable therapeutic service. Here’s how to deal with insurance companies so you can expand your client base and increase the profitability of your practice.
Do massage therapists need insurance?
As massage therapists are becoming increasingly recognized as healthcare providers, insurance billing will emerge from being optional to being a necessity. Making the extra effort to learn about insurance billing’s ins and outs will take the fear and difficulty away. The practitioners who shy away from this method of expanding a massage business are typically those who weren’t instructed to do it correctly. Don’t sell yourself short by limiting your practice; take the steps to learn how to correctly bill insurance companies.
Can you use modifiers for massage therapy?
They have denied claims in the past that had both 97124 and 97140 in the same session so be wary, and also make sure you are legally billing codes, modifiers are usually not used for massage therapy, also make sure that client isn't being seen for physical therapy, I was informed that if a physical therapist is using code 97140 than they will deny that code for massage therapy for that incident as there, 1. isn't enough distinction between the codes, and 2 because 97140 is a physical therapy code.
Is there a code for massage therapy?
Even though there are a plethora of massage techniques used by today’s bodyworkers, there are not enough codes to represent them . Whenever change enters a well-established institution, as massage therapy has entered mainstream medicine, it takes years for all of the components to reflect the change.
What are some examples of therapy services not covered by Medicare?
For example, services related to activities for the general good and welfare of patients, e.g., general exercises to promote overall fitness and flexibility, and activities to provide diversion or general motivation, do not constitute (covered) therapy services for Medicare purposes. Services related to recreational activities such as golf, tennis, running, etc., are also not covered as therapy services.
What is correct coding in Medicare?
This policy is used to promote correct coding by physicians and to ensure that it makes appropriate payments for physician services. [6] “This policy has been developed and applied by many third party payers across the country.” [7] Correct coding emphasizes that procedures should be reported with the CPT codes that most comprehensively describe the services performed e.g., 98941 is a more comprehensive code than 98940. There are procedural codes that are not to be reported together because they are mutually exclusive to each other. Mutually exclusive codes are those codes that cannot reasonably be done in the same session. An example of mutually exclusive codes germane to this policy is 97140 – Manual therapy techniques (without the -59 modifier) vs. 98940, 98941, 98942, or 98943 – Chiropractic manipulative treatment.
What is the CPT code for traction?
CPT code and description 97010 - Application of a modality to 1 or more areas; hot or cold packs - average fee amount - $10 - $20 97012 - Application of a modality to 1 or more areas; traction, mechanical 97016 - Application of a modality to 1 or more…
How many visits should a patient have for modalities?
If a patient is unable to endure therapeutic procedures due to the acuteness of the condition, the number of visits for modalities should not exceed 2-4 visits.
What is the expectation of rehabilitative therapy?
In the case of rehabilitative therapy, the patient’s condition has the potential to improve or is improving in response to therapy, maximum improvement is yet to be attained; and there is an expectation that the anticipated improvement is attainable in a reasonable and generally predictable period of time.
Is Medicare reasonable and necessary?
To be considered reasonable and necessary, the services must meet Medicare guidelines. The guidelines for coverage of outpatient therapies have basic requirements in common.
Is therapy required for abdominal surgery?
Therapy is not required to effect improvement or restoration of function where a patient suffers a transient and easily reversible loss or reduction in function which could reasonably be expected to improve spontaneously as the patient gradually resumes normal activities (CMS Publication 100-02, Medicare Benefit Policy Manual, chapter 15, section 220.2(C)). For example, therapy may not be covered for a fully functional patient who developed temporary weakness from a brief period of bed rest following abdominal surgery. It is reasonably expected that as discomfort reduces and the patient gradually resumes daily activities, function will return without skilled therapy intervention.
Spotlight
The Therapy Services webpage is being updated, in a new section on the landing page called “Implementation of the Bipartisan Budget Act of 2018”, to: (a) Reflect the KX modifier threshold amounts for CY 2021, (b) Add more information about implementing Section 53107 of the BBA of 2018, and (c) Note that the Beneficiary Fact Sheet has been updated.
Implementation of the Bipartisan Budget Act of 2018
This section was last revised in March 2021 to reflect the CY 2021 KX modifier thresholds. On February 9, 2018, the Bipartisan Budget Act of 2018 (BBA of 2018) (Public Law 115-123) was signed into law.
Other
On August 16, 2018, CMS issued a new Advance Beneficiary Notice of Noncoverage (ABN) Frequently Asked Questions (FAQ) document to reflect the changes of the Bipartisan Budget Act of 2018. Please find the document in the below Downloads section titled: “August 2018 ABN FAQs”.
Does insurance cover massage therapy?
For private payers, you must call the insurance company and find out if they cover massage as performed by a Licensed massage therapist, or if they cover it if done by the LMT but supervised by a Physician. They may cover under both scenarios. (If by "physician" you mean "chiropractor", the LMT may have to be a Certified or Licensed Chiropractic ...
Does LMT have to be supervised by a physician?
The written prescription should be sent to the ins. co with each bill. The LMT does not necessarily have to be supervised by a Physician in the case of MVA/WC, but even if they are, the insurance should pay for it, again, with the prescription.
Does Medicare pay for massage therapy?
A Licensed Massage Therapist can bill those codes under the Physician they are supervised under; Medicare does not pay for those codes, but private payers, WC, and MVA may, depending on the patient's policy.
Do you need a prescription for a massage?
You may need a referral or prescription from the Physician in order to be paid. For WC and MVA, depending on the laws of your State, the codes you mentioned should be covered if performed by a Licensed Massage Therapist if the patient has a written prescription for the massage from a Physician.
Can LMT bill for 97112?
The LMT can bill for 97110 and 97112, but the documentation needs to be very specific as to what they are doing to justify these codes. I used to bill for a Chiropractor and many private payers did not understand what neuromuscular re-education (97112) was - we had to send a letter explaining what it was and where/what in the doctor's note described/showed that therapy was being done.
