Massage Therapy Billing

[QueenAlicia]

Does anyone have any experience with massage therapy billing? 

What CPT/ICD 9 codes are used often.  I have a possible new client so I'm just interested how the billing is (difficulty).

[DMK]

We bill for massage therapy, but it's done here in our office under the doctor's direction.  We use 97140-59 as myofascial release (because there's always something else done on the same day) and the number of 15 minute units (we do 30 minute and 60 minute). 

97124 is the massage code for most massage therapists not under the doctor's orders.  This is for the standard effleurage, pettrisage, and tapotement. 

When checking benefits VERIFY that MASSAGE is covered when done by a therapist NOT in a doctor's office.  many plans have carved this out, or only allow it in a doctor's office under the doctor's direction.

CPT can vary in the doctor's office but there should always be 728.85 muscle spasm, or 729.1 Myalgia and Myositis.

Hope that helps.

[QueenAlicia]

Thanks for the information.  It helps a lot 

[QueenAlicia]

The clients are a group of self employed therapists.  I am wondering how the insurances pay.  I don't want to overcharge them for services.

[DMK]

This is where you HAVE to verify benefits carefully.  More and more insurance companies are carving out massage benefits.  You'll probably ALWAYS have to have the referring doctor's info, and it's important that you talk about UNITS with the therapists.  You can bill (for example) a one hour massage at $100, 1 unit, Blue Shield (here) pays a little over $25 per unit cascading down for the extra units.  If you bill 4 units @ $25 per unit (still $100) you get paid around $70.  Aetna only allows 3 units but pays more than $25 per unit, and doesn't cascade.  Blue Cross pays $9.17 per unit (some policies ONLY allow 1 unit, period).  So it's really important to check benefits and allowables and if the patient's policy has restrictions, either limit the treatment or the patient agrees to pay the difference. 

Since we do 30 minute and 60 minute massage, we have always broken it down in units.  If the doctor does active release on one area, that's one unit.  And we would only bill one unit for that.

Most therapists in our area won't even bill insurance because it's too complicated.  When it's done in the doctor's office it's easier.

[QueenAlicia]

If the therapists is out of network will the insurance company pay more?

[DMK]

If the patient has out-of-network benefits they should.  Then it would be based on U&C, or a $ limit, or a fixed percentage, that will be outlined in their benefits.  OON also means you can bill the patient the difference, and they have to pay it.  Really important that they realize they can't just write off the patient's portion.  The patient has a contract with their insurance company agreeing to pay their portion. No out of pocket is NOT legal.

[QueenAlicia]

Thanks DMK!

The meeting went very well.  I am submitting a proposal to them and they are waiting to sign the contract.

They are a mobile massage therapists group and they weren't aware of the per unit way of billing.