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Billing and Coding for Moxibustion
Q: I am trying to locate a code for cupping and moxibustion, and have had various fellow acupuncturists indicate that they bill using the existing codes for heat, 97010 hot packs or 97026 infra-red for moxa and 97016 vasopneumatic device for cupping.
Chiropractic Around the World: WFC Country Reports December 2015
The following country updates are reprinted with permission from the December 2015 World Federation of Chiropractic (WFC) Quarterly World Report. Information is excepted for space and edited to DC-specific style guidelines.
Forgotten Options for Musculoskeletal Health
Challenges with musculoskeletal health are of tremendous concern for many people today.
Changing the Cultural View of Medicine
Many hospitals in the U.S. are incorporating integrative clinics that include Traditional Chinese Medicine. Cleveland Clinic has led the charge for adding a traditional Chinese herbal medicine clinic to their existing acupuncture program.
Taking Another Step Toward a Secure Future
In 2008, the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) released a literature review on chiropractic care for low back disorders.
Integrative Medicine Can Shape the Profession
As the AOM profession struggles to define the role of "integrative" medicine within their practices their schools and organizations, students, faculty, alumni and administrators at schools wrestle with discussions of how much, where, how, and what to "integrate."
How to Humanize Your Content to Create Stronger Relationships
Content marketing is about building relationships, whether that is through updates on social media, offers on your website, blog posts, email campaigns, or even printed material. Now days a business needs to make a human connection.
The MRI: What to Do With the Results
As I wrote in my previous article on this topic, it is my goal for you, the doctor, to be an expert in interpreting MRI images yourself; and to be able to independently make decisions based upon a combination of clinical presentations and findings, followed by the MRI images.
From Antiquity to Modernity: Huang Qin Tang at Yale Medical School, Part 1
Traditional Chinese medicine is a coherent medical system with several unique characteristics: it originated almost 3,000 years ago; in its area of origin, it has been practiced without interruption since its inception.
The Roots of Insomnia
One of the most common clinical presentations is insomnia. Next to digestive disorders, sleep disorders are one of the most common complaints the clinician will encounter in daily practice.
Asking the Insurance Rep the Right Questions
One of the first or last questions a potential patient often asks is: "Do you take insurance?" An ill-informed or optimistic, "yes" can result in delayed or non-payment. Instead, just say: "Let me check if you are eligible first."
Window of the Sky Points
The acupuncture points known as Window of the Sky are a modern creation. There is no reference in Chinese medical texts for an acupuncture point category called Window of the Sky.
Treating Pain: The Hypermobile Coccyx
When I write about the coccyx, I recognize that I am talking about a relatively small subset of patients. When I write for Dynamic Chiropractic, I am trying to reach 60,000 chiropractors.
Yo San University Helps Make LA Communities Healthier
An element of healthcare training often overlooked is the residual benefit to communities served by Acupuncture and Oriental Medicine (AOM) schools nationwide.
Ethics: The Glue That Holds Us Together
Kudos to the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) for creating a code of ethics for the nationwide profession and for deciding to make courses in ethics a requirement for certification renewal.
The Clinical Versatility of Milk Thistle (Part 2)
Evidence is growing that the silymarin complex of flavonolignans from milk thistle can impact serum ferritin and iron overload in various clinical circumstances.
Do Doctors Lie to Patients? (Do You Lie to Yours?)
In a previous column ["When Patients Lie (Bribe or Flatter)," Oct. 1, 2015], I discussed the issue of patients lying to doctors, and the many reasons why this can occur.
Diet, Nutrition and the Context of Risk (Part 1)
Food and supplement safety is a topic that often comes up when I speak to chiropractors for CE relicensing, even when it is not the advertised subject.
Interprofessionalism: What it Means and Why You Should Care
Interprofessionalism in education and in practice is a growing trend across health care in the United States. The idea that team-based care and collaborative practice can improve health care has been around more than 50 years.
Lab Rats (Roaming the Streets)
The title of this article is an accurate description of American consumers (regardless of age) in the modern era.
Percussion Therapy: An Experiment
My study of qi began more than 20 years ago — long before my study of TCM, points or pathways. It all started with an awareness in my hands and physical manifestations in the way of blockages while working on clients.
RAND Study Recruiting DCs
Dr. Ian Coulter, RAND / Samueli chair for integrative medicine and senior health policy researcher for the RAND Corporation, has issued a call for participation, recruiting doctors of chiropractic for a practice-based research study that will examine "the impact of evidence, outcomes, costs and patient preferences on the choice of treatment for chronic low back pain and neck pain."
East Meets West
Gung Hay Fat Choi. Welcome to the year of the Monkey. There will be fireworks for both January and February this year. What great celebrations.
Enhancing Performance in Cross-Fit Athletes
Cross-fitness centers are expanding in number and increasing in popularity. To remain relevant to this growing portion of society, practitioners need to learn about the exercises and injuries common to this group.
January, 2006, Vol. 06, Issue 01
"Incident To" Issues
By Cliff Korn, BS, LMT, NCTMB
Are we professional, or not? Should those who choose to practice under the term "massage therapist" have the option of being considered a health care provider? Are we part of a "profession" that can benefit or be harmed by the actions of outside organizations/professions? Can, or should, we politicize the work we do by letting regulators know our opinions?
Your answers to these questions likely will determine your comfort level with this monthly editorial.For the record, I answer all of them affirmatively. I'm hoping enough of you do, too, and will let your feelings be known about something that has insidious downside implications for segments of our profession.
I am speaking about the ruling the Centers for Medicare and Medicaid Services (CMS) issued to prohibit Medicare reimbursement for therapy services provided "incident to" a physician's office visit. As of July 25, Medicare will pay physicians for physical, occupational and speech pathology therapy performed in their office as an incident to service only if it's done by a licensed therapist (or an assistant therapist supervised by a licensed therapist). When CMS uses the term "therapist," they now mean only physical therapists, occupational therapists or speech and language/hearing pathologists. Previously, Medicare paid physicians for incident to therapy services even when other providers, such as massage therapists, athletic trainers or physical therapy aides, performed it. However, Medicare no longer considers physician supervision of these auxiliary providers to be sufficient. Under the new rule, physicians are not permitted to bill Medicare for therapy services performed by athletic trainers, kinesiologists, therapy aides, therapist assistants, massage therapists, or any other non-therapist professionals.
It appears to me that we, and many other professions, were out-lobbied by other groups. The December 2004 issue of PT Magazine had an article entitled, "Physical Therapists Win Change in Medicare 'Incident To' Rules." The PTs of the world seem happy with the law changes. It seems like such a simple thing on the surface - a ruling that says physical therapy must be performed by a physical therapist. That makes sense, doesn't it? I think massage therapy should be performed by a massage therapist, too! As they say, though, the devil is in the details, and the definition of what constitutes "incident to" therapy adversely affects many massage therapists. As you well know, there is a significant difference between the performance of "physical therapy" and the delivery of "physical medicine."
This issue has been on the radar screen for several years, but the "blip" was not a bright one because CMS was reporting that the proposed changes merely were a clarification of existing CMS policy, and it was required by a 1997 statute. A quick Web search brings much information suggesting this hardly was accurate. My own reading indicates a significant change in policy, as opposed to just a clarification.
Massage Today columnist Vivian Madison-Mahoney writes, "I attended the recent press event in Washington, D.C., where Coalition members spoke out and expressed their concerns on how the recent Medicare ruling has affected them. This ruling limits only PTs, OTs and SLPs to provide therapy to physician patients where Medicare is reimbursing for the treatment." She goes on to state, "Doctors everywhere are feeling the sting of this ruling in that they are not allowed to decide what treatment, and who is best to provide it, for their patients. Therapists and other qualified providers who have been allowed to provide treatment 'incident to' physician's services for the past seven years are now out of work across the nation due to this ruling.This includes nearly 1,200 lymphedema therapists who are mainly massage therapists, in addition to thousands of other qualified providers and massage therapists who treat other conditions for the Medicare patient such as musculoskeletal conditions."
So, how did this ruling occur? Was there a great expression of concern from physicians and patients? Apparently not, since many physician groups, including the American Medical Association, joined a coalition to try to stop the ruling! The AMA formally stated, "The AMA urges CMS to withdraw its proposed changes for incident to physical therapy services and re-issue a new proposal in a later proposed rule after consulting with all affected physician and other health professional organizations"
The National Athletic Trainers Association went so far as to file suit to stop the proposed change, but their suit was set aside. There are some 23 different professional groups who have formed The Coalition to Preserve Patient Access to Physical Medicine and Rehabilitation Services (www.coalitiontopreservepatientaccess.org/).
My concern, and the primary reason I am bringing this to your attention, is not because so many massage therapists get reimbursed by Medicare; they don't. I find this issue important because so much of what happens with Medicare filters down to the private segment. I am very concerned that the commercial insurance carriers will find this an attractive way to limit payment for currently covered services. This increases profits for the three select therapy groups, as well as the insurance carriers, to the detriment of the public and all other care groups who otherwise are qualified to perform the services. It also undermines the patient/physician contract, as neither will be able to choose the best provider for a specific service. Make this a personal issue - see yourself, a parent or another loved one as a Medicare recipient in need of postsurgical lymphedema treatment. Now, decide if you'd rather have the treatment performed by any PT (because it could be reimbursed), or by a massage therapist specifically trained in lymphatic drainage. Medicare patients who seek "therapy-incident to" services from anyone other than a physical therapist, occupational therapist or speech/language pathologist might be denied coverage.
I strongly urge you to visit the Web site listed above and read the links listed under "Coalition Information." Then contact your professional associations to see what they are doing about this. Follow up by getting involved personally, and make calls to your congressional offices and let them know what actions you'd like taken. It's my opinion that CMS should revise its current ill-conceived "incident to" policy and revert to the one that since 2001 has stated that "any individual" can provide therapy services. What do you think?
Thanks for listening!
Massage Today encourages letters to the editor to discuss matters related to the publication's content. Letters may be published in a future issue or online. Please send all correspondence by e-mail to , or by regular mail to:
Former editor of Massage Today, Cliff is owner of Windham Health Center Neuromuscular Therapy LLC. He is nationally certified in therapeutic massage & bodywork and is licensed as a massage therapist by the states of New Hampshire and Florida. Cliff is a member of the International Association of Healthcare Practitioners; a professional member and past president of the New Hampshire chapter of the American Massage Therapy Association; a certified member of the Associated Bodywork & Massage Professionals, Inc.; and a past chairman of the board of directors of the National Certification Board for Therapeutic Massage & Bodywork.
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