Massage CPT Codes

Massage Current Procedural Techniques or CPT Codes are the codes that you need to describe your massage services to insurance companies.  The CPT codes are created by the American Medical Association (AMA).  Here is some information on how massage CPT codes are created on the AMA Website.

The basic Massage CPT codes are as follows:

97124 -Therapeutic Procedure, 15 minutes. One or more areas, including effleruage, pettrissage and/or tapotement, compression, percussion.

97140- Therapeutic Procedure, 15 minutes. Mobilization, manipulation, manual lymphatic drainage, manual traction, one or more regions.

97122- Therapeutic Procedure, 15 minutes. One or more areas, Neuromuscular re-education of movement, balance, coordination, kinesthetic sense, posture and proprioception.

97010 – Hot/Cold Packs

What code you use depends on what training you have and what codes the insurance company will allow.  You choose the code that best describes your training and skills.  Insurance companies usually pay different rates for different codes but you should not pick a code just because you will get paid more.

Because most of these codes are timed codes, you also must include in your chart notes the amount of time you spent on each area.  There is an 8 minute rule (See this document at CMS.gov (PDF) and search for 8 minute rule):

When only one service is provided in a day, providers should not bill for services performed for less than 8 minutes. For any single timed CPT code in the same day measured in 15 minute units, providers bill a single 15-minute unit for treatment greater than or equal to 8 minutes through and including 22 minutes. If the duration of a single modality or procedure in a day is greater than or equal to 23 minutes through and including 37 minutes, then 2 units should be billed. Time intervals for 1 through 8 units are as follows:
Units Number of Minutes
1 unit:  8 minutes through 22 minutes
2 units:  23 minutes through 37 minutes
3 units:  38 minutes through 52 minutes
4 units:  53 minutes through 67 minutes
5 units:  68 minutes through 82 minutes
6 units:  83 minutes through 97 minutes
7 units:  98 minutes through 112 minutes
8 units:  113 minutes through 127 minutes

Coding Tips:

  • Only use one of these codes on a bill; 97140 or 97124. Don’t 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 doesn’t necessarily mean it is acceptable.  You are responsible for billing the proper codes.
  • Questionable codes are: 97110, 97112, 97530, 97001-97006 (which are codes dealing with evaluation and re-evaluation).  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.
  • Have Patience!
  • 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 :  Insurance Billing 101 for Massage Therapists.    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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Getting health insurance to cover massage therapy

One of the next steps in the future of the massage profession will be getting more health insurance companies in the US to pay for massage therapy.  It is already happening plan by plan in various states and some companies are setting up alternative health benefits for their employees and allowing a yearly benefit for massage therapy.

In WA State, where I live and do massage, we have been able to bill health insurance companies since around 2000.  It was after a long battle between the insurance commissioners office and the insurance companies.  In April of 1993 the WA State legislature adopted the ‘every category of provider law’ (RCW 48.43.045)  mandate as part of the 1993 Health Care reform Act in WA that was created by the insurance commissioner at the time – Deborah Senn.  The statute was supposed to go into effect in Jan 1996, but the insurance carriers filed a lawsuit to have a court decide the correct interpretation of the law.

In Jan. 1999, The US Supreme Court finally ended all of the court battles and the ‘every category of provider’ law allowed massage therapists, acupuncturists and Naturopathic Doctors to become contracted providers with health insurance companies and get paid for medically necessary massage.

Deborah Senn, as I later found out after hearing her speak at the Massage Therapy Foundation Research Conference in 2010 in Seattle, created the mandate because she was a big believer in massage and got massage herself from a very politically active massage therapist – Lori Belinski (who is now actually working for the WA State Chiropractic Association).  Together they stood up for the profession and fought many years to get the law enacted.

That is all it took folks!  It didn’t take having better education standards.  It didn’t take having more research to show how massage works.  It didn’t take anything else but having a savvy insurance commissioner take a stand for the massage profession.

So how it works now in WA State, is that massage therapists who are already providers with the insurance companies can bill for injuries and conditions for massage.  The benefits usually read something like :

Massage therapy may be considered medically necessary when performed to meet the functional needs of a patient who suffers from physical impairment due to disease, trauma, congenital anomalies, or prior therapeutic intervention. Maintenance programs are considered not medically necessary.

There is one problem though.  Currently, most (if not all) of the insurance companies have closed their provider lists making it impossible to get on the provider list, so new massage therapists right out of school can not apply or get on the lists.  They say that the reasons are that there enough massage therapists to provide care.

But those massage therapists who are on the provider lists are able to bill health care insurance like Aetna, Regence Blue Shield and Premera Blue Cross, Group Health and First Choice Health and all of the insurance companies.

Yes there are still many downsides to billing insurance such as not being able to get on provider lists and also having benefits for massage reduced and allowable fees reduced.  The other side is that many people who are hurt or injured or in pain and who might otherwise not ever seek massage as a part of their medical care are able to get regular weekly or twice a week massages (depending on the prescription) and many doctors are seeing how massage can help with things such as carpal tunnel, back pain and other injuries that may have required surgery.  Well that is another one of the things – many doctors still do not know that massage can help reduce the possibility that a patient/client may have to get surgery.

Deborah Senn also spoke of this at the conference saying that the biggest challenge in getting the insurance companies to accept massage and acupuncture – the insurance companies thought that they would have to be paying $20,000 for the surgery (or whatever the cost – I am just making that up for example) and then another $1-2,000 for the massage therapy.  They did not realize that it could be saving them money.

Currently in my personal practice, I still do not get that many referrals from doctors for things like carpal tunnel and herniated discs.  Most of the prescriptions are for people with back and neck pain and occasional pulled muscles.  There is still more work to be done in educating doctors about massage, as well as insurance companies.

So if you are interested in getting massage covered in your state – start with your insurance commissioner.  Then start looking at the Affordable Care Act and find out what your state is doing.  There is a chance that the ACA could bring many opportunities for massage to be covered on health insurance.  If you do not know what is going on in your state you should start with contacting your local AMTA chapter.  If they don’t have any information, they need to start a committee to start working on it.

Yes I know, there are many of you who don’t want the headaches of billing or don’t want to jump into the arena with insurance companies and medical professionals who would often rather use drugs and pay for drugs and that also are not about health but are about money.  Yes it is a very different world than most massage professionals who are all about caring and helping.  You can be a part of the medical profession and still not buy into ‘their’ world.  You can stay true to being a massage therapist and preserving the art of massage and combining it with the medical profession.  It will require getting much needed support from your fellow massage therapists in the way of peer groups and supervision.  It will require you to really keep up on your self care and not get drained from billing insurance.  It will require that you set and keep boundaries more than ever and learn to take cases that support you rather than drain you.  It can be done.

You can learn more about how to bill insurance in my book Insurance Billing 101 for Massage Therapists .

 

HIPAA for Massage Therapists

Health Insurance Portability and Accountability Act (HIPAA) was created in 1996 to help protect the privacy of patients especially when health care professionals are using electronic billing, fax and email to send information back and forth.  It is still unclear and confusing as to whether or not every Massage Therapist needs to be HIPAA compliant or not.

To find out if you need to be HIPAA compliant you can go to the US Dept of Health website  it says:

A Covered Entity is one of the following:  A Health Care Provider…..but only if they transmit any information in an electronic form in connection with a transaction for HHS has adopted a standard.

and look at the PDF but here is what it basically says:

Does the person, business or agency transmit (send) any covered transactions electronically?  If NO, then it says the person is not a covered entity.

So the question then is – what is a covered transaction?  They explain it clear as mud in the PDF.

In the book, Introduction to Massage Therapy By Mary Beth Braun, she says this about a covered transaction:

Covered transactions include using any electronic means to transmit a persons health insurance information such as claims, enrollment, eligibility, explanation of benefits (EOB), premiums, claims status, referral certification, or authorization, and coordination of plan benefits.  If your business performs any transactions electronically (computer, electronic media storage,  email, internet, personal data assistants etc), then your business is considered to be a covered entity.

Cherie Sohnen-Moe in this Massage and Bodywork Magazine article also says that even if you don’t send things electronically that you need to be HIPAA compliant.

When you maintain client records, gather information from a client, engage in oral communication or transmit records (whether electronic or not), you are considered a covered entity.

If you work for other doctors/healthcare providers that are HIPAA compliant, you also have to be compliant.

To be HIPAA compliant you will need to create a manual for your office that gives the details about what you will be doing under various circumstances with clients information.  You will need to have clients sign your HIPAA policy and let them know of any changes in the way you will use their information or secure their information.

So what do you need to do to become HIPAA compliant?

  • You need someone in your office to be in charge of this (YOU!) and create a manual.  If you hire people to work for you, they need to be aware of the rules.
  • Create privacy policies on how you will keep personal health information private.
  • Install locks on your computer and file cabinets
  • Create a privacy notice for email/text communications
  • Give each client a Notice of Privacy Policies form to sign.
  • Don’t let clients see your appointment books with the names of people
  • Get and National Provider Number (NPI) (Directions from Vivian Madison Mahoney on Massage Today) so that you can bill electronically
  • If you collect people’s email address on your intake form, tell them how you will be using it.
  • If you plan on selling your business you will need to ensure privacy is maintained with the new owner.

Resources:

Articles online:

An Update on HIPAA Living the Law By Cherie Sohnen-Moe Originally published in Massage & Bodywork magazine, December/January 2004.

Everything You Ever Wanted to Know About HIPAA An Interview With HIPAA Authority Howard Ross By Editorial Staff Massage Today

HIPAA recommendations by Susan Salvo on Massageprofessionals.com

HIPAA Forms – www.sohnen-moe.com

US Dept of Health – are you a covered entity?

Insurance Billing for massage services – Make it so.

The AMTA 2012 Industry fact sheet says:

More than half of adult Americans (59 percent) would like to see their insurance cover massage therapy.4
The vast majority of massage therapists (96 percent) believe massage therapy should be considered part of the health care field.

I was a little shocked by those numbers thinking that they were really high.   It always seems when the topic of insurance billing comes up that there are many who don’t want it saying things like:  It will take away from true healing,  We won’t be able to work on other areas of the body that are needed and will just be limited to the diagnosis, we don’t want the hassles with paperwork and HIPAA, we don’t want to wait forever to get paid and then be asked to reduce our fees.

If massage becomes a part of the health care system, it won’t be as difficult to bill and get paid – at least not from what I see has happened here in WA State where we already have the ability to become contracted providers with health insurance companies.

Yes there is a lot to learn and a lot to keep up with.  In return you will get a steady stream of clients (yes I still call them clients- maybe it’s the one way I hold on to the art of massage). It has been one thing that has supported me in being able to survive in this profession for 24 years.

There is a really big opportunity going on right now that would allow massage therapists in every state to get massage covered by health insurance.  It is the Affordable Health Care Act (that I wrote about previously on my other blog) which is about to be fully implemented when the states open their health insurance exchange systems (government site ) in 2014.  From what I understand states can also opt out and use whatever Federal System is being created. Currently they are making the plans as to how to create and implement them. There is more info on each state in that last link.  There are still many unanswered questions like what will happen to our current plans and how can massage get on the list of providers as mandated in  (Section 2706) to be enacted into law reads in part: ‘A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law.’”

I am not sure if that means that the massage therapists will need to be licensed by the board of health in that state.  WA and FL and a few other states are under the Department of Health.  Most others are under a Professional Licensing division or board of massage and I am not sure if that would make us be recognized as health care providers or not.  Do we need to be licensed under the Board of Health?  I am wondering if that is how massage is covered in WA and FL although I thought someone on Facebook just said that in NY massage therapists can bill health insurance. (Could someone there verify that?)

So why am I so focused on getting everyone to learn how to bill and to get involved in the process of getting massage covered by insurance?

Because if we (the massage profession)/you as a massage therapist don’t get involved, you will have to just put up with whatever the insurance companies and insurance commissioners decide for us/you.   Or as John Weeks of thethe Academic Consortium for Complementary & Alternative Health Care (www.accahc.org) who spoke at the Alliance for Massage Therapy Educators conference in Tuscon in 2012,  said (and others have said)

“If you are not at the table, you are what is on the menu”.  

Learn How to Bill Insurance for Massage and work to get massage covered by Health Insurance.

Massage Insurance Billing in WA State

WA State MT have been able to bill health insurance for massage since around 2000 or so.  There was a law created in 1996 that the insurance companies fought for years until it was finally made into law by the US Supreme Court.  The law we have here is called the ‘Every Category Law’ which mandates that every insurance company needs to have massage therapists on their panel of providers and cover massage. Here is a little history on how massage got covered by insurance in WA.

Here is an overview of how billing works here:

  • We have to sign up and fill out a bunch of forms and become a contracted provider for the insurance companies.  Currently most of the lists are actually closed but I have heard that some can still get on if they work for others or in an office that has others who are on.  One list has been closed for probably over 5 years or more.  I think there is still one list that is open.
  • You have to sign a contract.  Fees are set by the insurance company and they can change them at any time. The contracts are detailed in what providers can do and can’t do and even in what they can say and can’t say.  They do tell you when they change them.  Yes they have dropped over the years, but they still pay what is  a reasonable fee to many.
  • Clients/Patients need a prescription for massage.  It needs to have the diagnosis and the treatment plan (how many sessions for how many weeks) and it usually needs to end within 3 months.  A new prescription is needed after that.  (That is what one insurance company requires specifically so I just changed all my cases to that to make it easier)
  • Massage needs to be medically necessary.  Every company has their own definition of that but in general massage needs to be for a condition or disease or problem that massage can show improvement for.  (You can see some samples from the different insurance companies on my clinic website.  That needs to be updated, I just realized but it will give you the idea!)
  • We have to do an intake on each client and get all their insurance information for billing.
  • They need to sign HIPAA forms that just say how we will use their personal information and how we will protect it.  You can get the forms online at www.sohnen-moe.com/forms
  • We need to do SOAP charts on each client showing improvement.
  • When the client is better, even if it is before the end of their prescription, the sessions are done.  Maintenance massage is not usually allowed.
  • There are one or two plans that do allow for preventative massage.
  • Massage therapists can use services like www.officeally.com which is a billing clearing house for free.  It allows the bills to be submitted to each insurance company electronically.  They also have a total practice management system that is free and they also have a system for taking credit cards through them.
  • Massage therapists have access to each insurance companies database online through www.onehealthport.com to check benefits and claims making it easy to verify coverage and benefits.
  • Most insurance companies pay within a few weeks of submitting the bills.  They have been sending checks with Explanations of Benefits.  They are moving toward direct deposit and getting the EOB’s online either through www.officeally.com or through the insurance companies website though onehealthport.com
  • Clients/Patients come once a week usually until they are better.
  • Most doctors ask for progress reports which is a good way to network with doctors and show them what massage is doing.
  • Clients/Patients will find you through the provider directory or will find you through your website so you need to have pages on insurance on your site. (That means you don’t have to do more marketing to get clients.  They find you!)
  • Clients will get better and move on or decide to come on a regular basis and pay cash later.
  • You will be talking to doctors and insurance companies so you need to know what you are talking about and doing

I personally see clients with back and neck pain, shoulder pain, knee pain, herniated discs, plantar fasciitis, carpal tunnel and just about any type of pain and things like fibromyalgia and headaches.  It does not cover massage for anxiety and depression which is interesting as the strongest research we have on what massage does is how massage does work for those conditions.

We are contracted providers with companies like Aetna, Cigna who are managed by a third party (Healthways Whole Health Pro), Regence Blue Shield, Premera Blue Cross, First Choice, Group Health and others.

Yes they do change things up a lot and you have to stay on top of everything.  You have to know what is covered and what the rules for billing are.  There are way fewer billing issues now with things being so automated but there are still headaches.  It is just a matter of staying informed.

See also:

Insurance Billing 101 for Massage Therapists – the Ebook/Book