Q/A: How do we Bill Massage Services?

January 21st, 2020 - Wyn Staheli, Director of Research
Categories:   CPT® Coding  
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Question: We are adding a massage therapist soon and have some questions about billing their services.

  1. Are there different codes for different types of massage?
  2. Does insurance pay for extended massage (60-90 minutes)?
  3. How do you change the value of the massage code depending on who provides the service (it seems a higher fee should be attached when its an LMT performing the service over a CA , or higher yet if the doctor performs the service)?

Answer:

The CPT code for massage is 97124 which is a timed-based service which is reported in 15 minute increments. There is only one code for all massage (97124) so longer massage services would simply be reported using the proper number of units (e.g., 60 minutes = 4 units). For additional information on reporting these services, see “97124 Massage, Each 15 Minutes, One or More Areas” and “Timed Codes” in the ChiroCode DeskBook.

As for most other services, whether or not insurance will pay for the service depends on the individual plan. Some don’t and some do. In fact, we’ve heard of some plans that require massage to be performed on the same day as CMT, while other plans state that massage can NOT be performed on the same day as CMT. There is no hard and fast rule, so you will need to verify coverage.

As for WHO may perform massage services, check with your state licensing board as to whether your chiropractic assistant is allowed to perform massage in your state as your delegated agent. Note too that payers may have specific guidelines regarding this as well, and may not cover massage unless performed by a properly licensed individual.

Note: If the therapist is licensed and recognized by the state to perform other services, then use the codes for the other services as well.

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