What is a modifier in CPT?
Modifiers increase the specificity of certain CPT codes. Modifier -59 indicates that the procedure (97140) represents a distinct service from others reported on the same date of service. This modifier was developed explicitly for the purpose of identifying services not typically performed together. General Modality Guidelines
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)
Is it appropriate to append the CPT code 97140 with a modifier?
On these occasions it is appropriate to append the CPT procedural code 97140 with a modifier (-59).
What does the modifier-59 mean on a procedure?
Modifier -59 indicates that the procedure (97140) represents a distinct service from others reported on the same date of service. This modifier was developed explicitly for the purpose of identifying services not typically performed together.
What modifier do I use for massage therapy?
-59Modifier “-59” & 8-Minute Rule According to the National Correct Coding Initiative (NCCI), massage therapy (97124) and manual therapy (97140) are considered to be linked, meaning if one of these codes is billed, only one payment may be received despite two services being provided.
What modifier should be used with 97112?
Neuromuscular re-education (97112), massage (97124), and joint mobilization (97140), require a 59 modifier on the preceding codes if done on separate regions from the chiropractic manipulation.
What modifier should be used with 97140?
modifier -59The 97140 CPT code is appended with the modifier -59 or the appropriate -X modifier.
Can a massage therapist bill CPT code 97140?
The CPT codes massage therapists can use without question are: 97010 - hot and cold packs; 97124 - massage; and 97140 - manual therapy.
Should I use modifier 59 or XS?
Effective January 1, 2015, XE, XS, XP, and XU are valid modifiers. These modifiers give greater reporting specificity in situations where you used modifier 59 previously. Use these modifiers instead of modifier 59 whenever possible. (Only use modifier 59 if no other more specific modifier is appropriate.)
Does Medicare pay for CPT 97112?
In addition to 97530, CPT code 97112 “neuromuscular reeducation” also exceeded 97110 in billing increases. Medicare now pays an average of $4.50 per unit more for 97112 than 97110.
Does Medicare pay for 97140?
Also, Medicare NCCI edits categorized 97140 as a component of CMT, unless a modifier (e.g., -59) is used for a different region(s). However, Medicare law prohibits coverage and payment for non-CMT services. Thus, if 97140 is bundled with or into CMT, it would be a violation of Medicare law.
Is the GP Modifier only for Medicare?
Modifiers GN, GO, and GP refer only to services provided under plans of care for physical therapy, occupational therapy and speech-language pathology services.
Can CPT code 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.
What is the difference between 97124 and 97140?
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.
How do you bill for massage therapy?
Once you've 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.More items...
How do you code 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).
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 a therapeutic procedure?
CPT codes within the code ranges of 97110-97124, 97140, and 97530-97542 require direct (one-onone) patient contact by the provider.
What is traction in CPT 97012?
CPT 97012 Mechanical traction is described as force used to create a degree of tension of soft tissues and/or to allow for a separation between joint surfaces. The degree of traction is controlled through the amount of force (pounds) allowed, duration of time, and angle of the pull (degrees) using mechanical means. Used in describing cervical and pelvic traction that are intermittent or static (describing the length of time traction is applied), or autotraction (use of the body’s own weight to create the force). A common question is whether a roller table type of traction meets the above-noted requirements. According to the ACA’s interpretation, table type traction would normally meet the requirements of autotraction.
What is the CPT code for constant attendance?
The CPT Manual defines a modality as “any physical agent applied to produce therapeutic changes to biologic tissues; includes but not limited to thermal, acoustic, light, mechanical, or electric energy.” CPT codes within the code range of 97032-97036 are “Constant Attendance” codes that require direct (one-on-one) patient contact by the provider. These codes contain a time component (15 minutes) and time is recorded based on constant one-on-one attendance.
What is S9090 code?
• All claims for this service must be coded using S9090, with one unit of service per day.#N#• Based on the lack of scientific evidence (blinded studies, appropriate number of participants in studies already conducted, documented long-term results) S9090 will be allowed based on the 97012 allowance and unit limitation guidelines.#N#• This policy will remain in effect until such time that scientific studies performed within accepted standards are available.#N#• To ensure correct coding of this service there will be periodic audits performed at random.#N#• Those claims found to have been coded incorrectly will require appropriate refunds and patients’ credits.#N#Policy Overview
How long can a therapist bill for a supervised modality?
In the same 15-minute time period, one therapist may bill for more than one therapy service occurring in the same 15-minute time period where “supervised modalities” are defined by CPT as untimed and unattended — not requiring the presence of the therapist (CPT codes 97010 – 97028). One or more supervised modalities may be billed in the same 15-minute time period with any other CPT code, timed or untimed, requiring constant attendance or direct one-on-one patient contact. However, any actual time the therapist uses to attend one-on-one to a patient receiving a supervised modality cannot be counted for any other service provided by the therapist.
What is CPT code 97140?
CPT Code 97140: Manual therapy techniques (e.g. mobilization, manipulation, manual lymphatic drainage, manual traction) one or more regions, each 15 minutes. [1] Description Code 97140 is used to report manual therapy (‘hands-on’) techniques that consist of , but are not limited to connective tissue massage, joint mobilization, manual traction, passive range of motion, soft tissue mobilization and manipulation, and therapeutic massage. Manual therapy techniques may be applied to one or more regions for 15-minute intervals. These services are not diagnosis or region specific.
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.
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.
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.
Can insurance companies reimburse massage therapists?
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 massage therapists be contracted?
A handful of states permit massage therapists to be contracted providers within the healthcare system. With new legislation constantly emerging, be sure to check on the most current insurance billing guidelines in your state. Additionally, experts in the field suggest using an insurance verification form prior to bill submission.
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.
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.
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.
What is the CPT code for massage?
AOTA requests that the reference to connective tissue massage and therapeutic massage be removed from this code, as massage is appropriately billed under CPT code 97124. To the extent that the reference was intended to include connective tissue mobilization and transverse friction massage as manual therapy techniques, AOTA would support these inclusions.
What are the criteria for CPT code 97140?
When reporting the CPT code 97140 in conjunction with CMT codes, there are six criteria that must be documented to validate the#N#service:#N#1. Manipulation was not performed to the same anatomic region or a contiguous anatomic region e.g., cervical and thoracic#N#regions are contiguous; cervical and pelvic regions are noncontiguous
What is massage therapy?
Massage is the application of systemic manipulation to the soft tissues of the body for therapeutic purposes. Although various assistive devices and electrical equipment are available for the purpose of delivering massage, use of the hands is considered the most effective method of application, because palpation can be used as an assessment as well ...
What are the goals of massage?
This would include such goals as to decrease pain, decrease muscle spasms, decrease muscle soreness, and increase circulation.
What is manual technique?
Skilled manual techniques (active or passive) are applied to soft tissue to effect changes in the soft tissues, articular structures, neural or vascular systems. Examples are facilitation of fluid exchange, or stretching of shortened muscular or connective tissue.
Does Blue Cross reimburse massage?
Blue Cross will not reimburse providers for massage or manual therapy. services (97124 and 97140). Massage or manual therapy will deny. either as incidental (provider liability) or subscriber liability. Massages that are provided as preparation for a physical medicine.
Is 97140 a CMT?
Also, Medicare NCCI edits categorized 97140 as a component of CM T, unless a modifier (e.g., -59) is used for a different region (s). However, Medicare law prohibits coverage and payment for non-CMT services. Thus, if 97140 is bundled with or into CMT, it would be a violation of Medicare law.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Article Guidance
Refer to Local Coverage Determination (LCD) L35036, Therapy and Rehabilitation Services (PT, OT), for reasonable and necessary requirements and frequency limitations. The Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) code (s) may be subject to National Correct Coding Initiative (NCCI) edits.
ICD-10-CM Codes that Support Medical Necessity
It is the provider's responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim (s) submitted.
ICD-10-CM Codes that DO NOT Support Medical Necessity
All those not listed under the "ICD-10 Codes that Support Medical Necessity" section.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
What is Massage Therapy?
The Mayo Clinic defines massage therapy as “a complementary treatment that involves manipulating the body’s soft tissues.” Massage therapy, in order to be classified as a medical treatment, must provided by licensed and certified massage professionals.
How Does Medicare Cover Massage Therapy?
Original Medicare (Part A and Part B) doesn’t 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.