Though more and more patients are beginning to seek out massage therapy, massage therapists still face difficulty when billing insurance payers for their services. While low rates of reimbursement are common for massage therapists, receiving reimbursement from insurance payers takes care and communication, through both the billing process and the services you provide to patients. Using the correct CPT codes for massage therapy can be key in proving medical necessity and receiving reimbursement from in-network payers. In this post, we walk you through the most common CPT and modifier codes to use when billing for massage therapy, and which to avoid to ensure reimbursement. If you’re unsure of how to bill clients through their insurance, Healthie can help you build Superbills with its Free Starter Plan. Simply click here to learn more.
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 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
- 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 Additionally, do not cite both of these codes when submitting for reimbursement without modifier code 59, discussed below.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.
There are two main modifier codes that can be used for massage therapy insurance billing code. The first is modifier code 59, which identifies two procedures, of similar nature, that were performed on the same individual within a single day or across a few days. Essentially, modifier 59 indicates to insurance companies that, if you bill for two or more procedures, these were distinct and different procedures. The second modifier code is code 52, which designates that a treatment modality was reduced by choice by the provider. This just means that while some parts of the service were performed, the full, usual procedure was not completely carried out.
Massage therapists should stay away from CPT codes meant for physical therapists. While some of the treatment modalities may be similar, massage therapists are not licensed or trained in the same way as physical therapists. Insurance companies are likely to reject any claim using the following codes: 97001-97006, 97110, 97112, 97350.
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
23-37 minutes: 2 Units
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, Healthie’s Free Starter Plan makes it easy and streamlines future client scheduling and payment processing. Simply click here to get started today.
Healthie for Massage Therapists
Healthie’s all-in-one software helps massage therapists streamline scheduling, billing, note-keeping, and client communication. Our free Starter plan includes features such as:
- Insurance billing: Generate CMS-1500 claims that can be batch-downloaded and submitted to your clearinghouse of choice. Easily track claim statuses and reimbursement within Healthie, or invoice clients for non-covered amounts.
- EHR: Leverage Healthie’s HIPAA-compliant electronic health record allows you to keep clients’ personal health information secure, and track client progress using custom-built chart notes.
- Packages and Invoices: Create custom package offerings and authorize client payments using our integration with Stripe. Generate invoices and receipts for payments.
- Online Booking: Healthie’s scheduling feature allows you to create custom appointment types, set availability, and book online via our web platform or mobile app.
- Client Engagement: Check in with clients between appointments using Healthie’s HIPAA-compliant chat feature.
Healthie allows you to focus on your clients while knowing your back-office responsibilities are handled. Learn more about Healthie for massage therapists here.
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