Forum - Questions & Answers

May 19th, 2021 - Anj 1 

97140 or 97124 and What Modifier?

Hello all.  I work for a chiropractor.  We typically bill chiropractic adjustments as 98941.  We also perform deep tissue massages on our patients and have previously billed those as 97140 with a modifier of 59.  (This was all set up before my co-worker retired and I inherited this part of the job.)  Suddenly Anthem is rejecting all our claims and stating we are using the wrong modifier.   I just got in a new ChiroCode Desk book and upon reading I am thinking I should be using modifier XR but I am not sure.  I also noticed that it lists the code 97124 as Massage and states that it is not interchangeable with 97140.  Does anyone know which CPT and modifier I should be using?  Typically billing with 98941 as well.  Thank you for all your help.  

May 19th, 2021 - ChrisW   256  1 

re: 97140 or 97124 and What Modifier?

The basic difference between those two is the "intent". If the purpose of the therapy is to promote relaxation and improve circulation, it is massage 97124. If the purpose is to improve function, such as range of motion, then it is manual therapy 97140.  Some payers simply don't cover massage at all so that's something to consider. There isn't a modifier XR, but I'm guessing you mean XS which is a separate structure meaning that they have to do a different region than the CMT and the diagnosis pointer must point to a different diagnosis than the CMT service.

May 20th, 2021 - Anj 1 


Sorry, that was a typo I was actually looking at the modifier XE.  However, it seems from what I have been able to gather since typing this that the CMS preferred modifier in our area is GP and so that is what I am going to try.  You did answer my question about what CPT code to use and based on that we are using the correct one of 97140.  thank you

Aug 31st, 2021 - Dr D 1 

re: 97140 or 97124 and What Modifier?

We've been experiencing the same problem with Anthem. Does anyone know if this worked? Did it get successfully billed (and paid for) as a "97140-GP" (or did it also need the -59 modifier and so get billed as a "97140-59-GP)?  

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