Massage Today
Massage Today dotted line
dotted line

dotted line
Share |
  Forward PDF Version  
Massage Today
May, 2011, Vol. 11, Issue 05

CPT Codes Revealed

By Vivian Madison-Mahoney, LMT

I have received many, many questions (via email and phone) regarding CPT (Current Procedural Terminology) Codes and massage therapists. This article is intended to help answer some of those common questions.

In particular, I've been asked numerous times about a massage therapist's ability to use CPT Code 97140 (Manual Therapy Techniques) versus a physical therapist's ability to use it.

97140 Vs. 97124

The CPT Code Book definition of 97140 is: "Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes."

You may also document myofascial release using this code. Most of us perform more than just basic Swedish massage when providing treatment to medically prescribed cases with a written prescription from the treating physician indicating diagnoses, duration and frequency. However, if what you perform is basic Swedish massage, then use CPT Code 97124.

CPT Code 97124: "Therapeutic procedure, one or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion)."

Often insurance companies will deny the massage practitioner the use of 97140, stating that it is a "PT Code" (i.e. physical therapy) and therefore, not in "your scope of practice". This is not true if you have training in myofascial release, manual therapy, manual lymphatic drainage, manual techniques such as neuromuscular therapy, structural alignment or other deeper tissue techniques, and if your training is sufficient to benefit the patient's medical condition. If you can stand up in a court of law and explain what you do, how you do it, why you do it and how it benefited the patient, then feel free to use 97140. If not, be safe and stick with basic Swedish massage, CPT 97124. These are the determining factors, and should never be whether or not it might pay more.

Documentation

Documentation is the key. With 97140, one must document the region (in conjunction with the prescribed diagnosis), exactly what was performed, and the time spent on each body area (e.g., 15 minutes). Remember when we are billing insurance, we follow the CPT, ICD-9 and other insurance-related rules and regulations. Fifteen minutes is 15 minutes, not 8 minutes or other Medicare rules. This is the same information I provide to fraud investigators and insurance adjusters when they have invited me to do presentations for them.

Please note the following statement is taken straight from the AMA CPT Coding Manual (2011 ed., located in the introductory pages). This is the same information that I use to help many massage therapists across the country to be paid on denied claims for using CPT Code 97140.

Current Procedural Terminology

  • "It is important to recognize that the listing of service or procedure and its code number in a specific section of this book does not restrict its use to a specific specialty group".
  • "Any procedure or service in any section of this book may be used to designate the services rendered by any qualified physician or other qualified health care professionals".

About 97001: Initial Evaluation and 97002: Re-Evaluation.

It is suggested these codes be used by PTs even though the CPT Code Book states no codes are for any specific provider group and even though massage therapists across the nation are using this code, I highly suggest (based on information received from the insurance industry) that for now we not use these codes.

The reason we suggest not using 97001 and 97002 is because in the CPT Code Book it is followed by codes specifically for Occupational Therapy (97003-97004) and then for Athletic Training (97005-97006), thus indicating the codes are specific to those licensed in those professions. Had there been only the 97001-97002 codes, it might be different.

About 97799: Unlisted Physical Medicine Procedures and/or Rehabilitation.

This code is required to be submitted BR "by report". Massage therapists providing an initial evaluation/assessment should have a sufficient report in the first place. There is also not a fee schedule for this code so ask an insurance adjuster in advance.

I hope all of this information helps you to better understand these codes. Just know that insurance adjusters are not trained in our type of work therefore are looking for (and have the right to ask for) additional information prior to reimbursement of claims. This is for the protection of policyholders as well.

Get Proper Training

One more note on insurance reimbursement. Billing insurance for reimbursement is much more than knowing a code and having a specific form; it is about knowing the guidelines inside-out and upside-down. Get proper training just as you did in order to provide hands-on services. Training and licensing is to "protect the public". Since we are treating ill or injured people and billing for payment from their insurance monies, consider knowing insurance billing for the same purpose: to protect the public as well as yourself.


Click here for more information about Vivian Madison-Mahoney, LMT.

 

Join the conversation
Comments are encouraged, but you must follow our User Agreement
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.
comments powered by Disqus
dotted line
No Prescription Cialis To Buy Viagra Viagra Patent Europe Viagra Best Buy Diet Pills Keyword Buy Viagra Online Cheapest Price For Cialis Can I Buy Viagra Edinburgh Uk Viagra Tid Cfm Erectile Dysfunction Cures Levitra Online Us Pharmacy Viagra Sale Online Cialis Levitra Pharmacy Viagra Cost Of Cialis Levitra En Espanol Silagra 100 Counter Drug Over Viagra Cheap Viagra Cialis India Buy Cialis Where Uk Viagra Sales Viagra Overnight Buy Cheap Sale Viagra Rx Pharmacy Generic Viagra Viagra Cialis Canada Viagra Samples For Free Viagra 100mg For Sale Generic Viagra Trial Pack Cheap Generic Viagra No Script Cialis Prescriptions