CPT Codes

What’s the process for billing insurance?

It’s a little bit of paperwork, but if you’re organized (or if you have a computer program that organizes for you), it’s pretty easy. For massage therapists, at least. Essentially, the billing form requires a diagnosis (as an LMT, I can really only diagnose pain and stiffness) and CPT codes, which lets the insurance companies know what procedures/techniques I used during the sessions.

The CPT codes honestly make more sense for doctors or anyone who does more than one thing in their session. Every procedure is broken down into small chunks, so that someone could bill just for a 15 minute increment of massage, if that’s all they did during an appointment. But since all I do is massage, that’s all I bill for. Four CPT units make up an hour session.

To turn a very simple process into a complex and infuriating headache, however, there are two separate CPT codes that refer to massage. I presume that these were invented so that insurance companies could distinguish between therapeutic massage, which is used often by chiropractors, and relaxation massage, which is seen more as the unloved stepchild of the CAM world (more on that below). Regardless, massage therapists use these codes interchangeably.

Here are the two codes:

97124 – Massage, including effleurage, petrissage, and/or tapotement (stroking, compression, percussion).

This code refers to basic Swedish massage techniques.

97140 – Manual therapy techniques (e.g. mobilization, manipulation, manual lymphatic drainage, manual traction).

While this code may seem less straightforward, if you look at the examples they give, you’ll note that most of these are styles of massage (with the exception of “[joint] mobilization”, which is more of a physical therapy and chiropractic thing). Indeed, when I looked for further details on “manual therapy”, many sources mentioned trigger point therapy.

As you can imagine, every massage I give is some combination of relaxation and therapeutic techniques. On an esoteric level, no massage is the same. Every massage therapist uses a different set of skills and techniques, such that the final product can’t just be given one of two generic labels.

On the more practical side of things, however, some insurance companies only allow me to bill for my massages by using the 97124 code. Some only allow me to use 97140. Other companies allow both, but will pay out at different rates (97140 earns more). Very few companies allow both and pay out at identical rates.

Why do they do this? Like I mentioned above, massage is at the lowest spot on the totem pole of complementary and alternative medicine. Despite research that shows how beneficial a simple relaxation massage can be, it’s still difficult for many people to believe that something that feels really good can also be good for you. [See previously.]

Insurance companies that only allow me to use 97124 are actually separating massage therapists out from other practitioners who might also use the 97140 code, paying us at a lower rate than other providers would find acceptable*.

Similarly, those companies that only allow 97140 are trying their hardest to muddle the fact that their customers can receive massages from massage therapists at all. Excluding Providence, most other insurance companies will tell me on the phone that “massage therapy” isn’t covered, but will then reimburse me for my session anyway when I bill them using the 97140 code. We can see this obfuscation here:

“Massage therapy” is not a covered service. This list of exclusions is at the top of the benefits page.

“Manipulative services”, however, are covered. That’s 97140. Of course, you’d have to scroll all the way down the page to find that out.

Several of my clients just switched to a new insurance through their employer, and they have plans similar to the one illustrated above. When an insurance rep came to tell them about their benefits, my clients asked him directly if massage was covered. He told them it wasn’t.

Luckily, I was able to explain to them the extra-particular particulars of the massage CPT codes. But what about those who don’t have a knowledgeable massage therapist on hand? It frustrates me that insurance companies can get away with lying to their customers about this.

The take-home message, then, is to check the details of your insurance plan. If you have any questions, don’t bother asking the insurance company. Just ask a provider.

*The most egregious example of this is American Speciality Health, which believes that a massage is only ever worth $45.

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1 Comment

  1. Julie rossberg
    Posted March 14, 2014 at 11:52 am | Permalink

    Might an example of this be the difference between chiropractors and physical therapists? If a client’s insurance doesn’t have a massage benefit, the workaround is to see a chiropractor. They give chiropractic care, including manual therapy (an hour massage), bill for it accordingly, and get paid. It’s common practice to get chiropractic even though a person doesn’t really want it, because they have to take it in order to get massage. What about other workarounds if a client *didn’t* want chiropractic? Could they go to a PT, which they might feel way more comfortable with, and in conjunction have massage – which the PT office would bill for (including the units of massage) and could similarly get paid? I work with both, but my PT clients have to pay cash, while my chiro clients are covered under insurance. If I could figure a billing workaround for my PT clients, they could afford to be seen more for massage…

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