January 2nd, 2007
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.
Nicole Cutler, L.Ac.
While running a cash-based business can be a successful venture, there are many reasons to consider accepting and billing insurance companies. Although you can have a successful massage business without billing insurance companies, knowing how to bill will come in handy when one of your clients asks you to bill the insurance company for them. You also can build a practice totally dependent on insurance cases and work with integrity when you know all the rules, regulations and issues.
Where Billing is Okay
All 50 states allow massage therapists to bill insurance companies for massage sessions with clients who are either injured on the job (workers compensation) or in a motor vehicle accident.
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. This form confirms that your client is covered by an insurance company who will accept your charges.
Six Insurance Billing Hints
Interacting with insurance companies correctly will pay off. The following hints will help any massage therapist realize that billing insurance isn’t very hard:
- Documentation assures payment – make certain your SOAP notes accurately reflect what occurred, chart progress and cover what you billed for.
- Always follow the doctor’s prescription.
- 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.
Procedure Code Tips
The American Medical Association produces a manual each year containing thousands of codes for known medical procedures. Due to the ever-changing field of medicine, this manual is revised yearly. While primarily intended for physicians, other medical modalities use the codes to describe and bill for the work they do. 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. Massage therapists use just a few codes from the Physical Medicine and Rehabilitation section of the CPT manual. Since massage therapists do not diagnose conditions, the ICD code must be acquired from a prescribing medical specialist.
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. Until the CPT codes catch up with techniques commonly practiced by massage therapists, codes must be used that fall within a massage therapist’s scope of practice and that accurately describe the therapy.
The two most commonly accepted codes for massage therapy are:
- 97124 Massage – This code is used for Swedish Massage
- 97140 Manual Therapy Techniques – This code encompasses manual traction and manual lymphatic drainage therapy
As the code guidelines can change, double check which code is appropriate for myofascial release. In our research we discovered conflicting information regarding the code for myofascial release. 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. 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.
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.
Denning, Ed, Massage Therapy Medical Codes for 2004, Massage and Bodywork, February-March 2004.
Madison-Mahoney, Vivan, Coding for Insurance Billing and Medicare Issues, Massage Today, February 2006.
www.thebodyworker.com, Introduction to The Massage Insurance Billing Manual, Julie Onofrio, LMP, June 2004.
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