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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17 thoughts on “Massage CPT Codes

  1. Interesting article. Of note, under Florida PIP Law, massage therapy is a non-covered benefit, and furthermore, any services rendered by a licensed massage therapist is non-covered .

    • Yes but I thought you could still bill as a 3rd party claim and get paid when the case settles – is that right? There are many laws and rules in each state and with each plan that you have to be aware of.

  2. FL MTs got their PIP billing rights yanked from them a couple of years ago via change in billing laws. Too many were taking ill advantage of the opportunity to bill and abusing their rights.

  3. I am new at this so I need all the help I can get–I would like to know how to billing Mi. does each insurance have their own codes for massage? is it the same as an NPI code? do I need an NPI code? because when I looked up massage therapist was not listed.
    thank you for any info

  4. Hi Julie, I’m wondering about the 8 minute rule for LMPs in Washington state. The link you provided is for Medicare/Medicaid Services, and their Claims Processing Manual, which doesn’t seem to apply since Medicare doesn’t cover massage therapy, as far as I’ve heard in our office (I work in a chiro/massage office on the Eastside). The other therapists and I each learned in school here in Washington that 13 out of 15 minutes had to be fulfilled in treatment or intake/outtake to bill for that unit, versus the 8 minute rule that is stated above. Obviously that’s a big difference! Do you have any other sources for that minute rule to bill for a unit for LMPs?

    Thank you!

  5. Thank you for the article. Would you please share a link from the AMA website where these codes and Medical Massage or at least Massage is mentioned? I tried to reference their website and the information is unavailable. Please help. I have a private pay client who I am working with to try and get their insurance company to assist in the cost. In addition to that I am also working with a Pain Management Clinic and any visible reference I can use to validate the work I do with using Massage as medicine would be helpful, especially from the AMA. Thank you.

  6. I thought there was a precedent set a few decades ago that covered massage therapy for PIP/MVA nationally? I noticed therapists from FL mentioning having their ability to bill for PIP/MVA revoked. Please explain. Here in KY, we can bill for MVA, workman’s comp and disability. The latter two, however, only pay about $20/hour/treatment flat rate.

    • FL can’t bill PIP because of a restriction put on them a few years ago with some new law there. They were supposedly overbilling and got caught although there is more to it than that.

  7. This is very helpful info! I’ve been a massage therapist in Vanvouver, Wa for 4 years now, but have had the luxury of working for a chiro who took care of all this for me. However, I’m now branching out and starting my own private practice and am learning A LOT…This insurance stuff is no joke. This has all been helpful. I was under the impression that I can only bill under 97124, and that 97140 is for chiro massage. Clearly I was informed wrong. The other tricky part is the diagnostic codes…cause we can’t diagnose. So much to learn!

  8. @Sara Funk. Just an FYI, when billing for an MVA if your client is also getting Physical Therapy and it occurs on the same day as the massage and 97140 is used one provider will not be paid by the insurance company. Physical Therapists use the code 97140 for manual therapy. No insurance company, MVA/PIP or otherwise will pay two providers providing treatment on the same day that are using the same CPT code.

  9. On another note, massage therapists will be happy to learn that a school district in Southern Oregon covers massage therapy for the treatment of pain when prescribed by a PCP. This is part of their employee’s medical health benefit package.

  10. One thing to remember are that rules vary state to state so you need to look up rules specific to your state. In Oregon, 97122 is not a valid code. IT is sad that there is no standard and that some people abuse it. We are fighting to keep our billing rights here in Oregon now as well. Chiro offices don’t want us to bill so they can have all of the money and maximize their profits by paying therapists a low wage.

  11. Hi Marje
    I practice in Michigan and i have an NPI and have billed workers comp and PIP for auto. When you apply for NPI it will not have massage therapist it will be under Respiratory, Developmental, Rehabilitative and Restorative Service provider this is for all massage therapist to get the NIP# Taxonomy for this is 225700000X

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