Massage therapy is medically necessary for a lot of people. The health benefits are numerous, and it’s a proven treatment for many ailments. Massage being covered by insurance makes it more accessible to people who couldn't afford it otherwise. However, massage billing is complicated. Billing insurance requires a bit of know-how and a lot of time. Even then, there’s a chance you won’t get paid.
If you’re considering insurance coverage as a payment option, you need to understand a few things. First, know what’s required of your practice to be able to bill insurance. Then familiarize yourself with the massage billing process. Learn common CPT codes, and understand what might cause your claim to be denied.
Is billing insurance the right move for your massage practice?
There’s no doubt that massage clients would love it if their insurance paid for your services. For some of them, that’s a real possibility. However, in many cases, massage therapy is not covered by insurance.
The first thing you need to research is which providers cover massage therapy in your area. Coverage for massage therapy varies by region and provider. For instance, in some Canadian provinces, massage therapy is a common benefit. In the United States, coverage for massage therapy is not typical. However, that’s slowly changing. There are a few insurance plans that cover massage therapy. Workers' compensation and auto insurance also cover massage therapy.
Do you have time (or the staff) for massage billing? Billing insurance takes time and paperwork, sometimes A LOT of it. It’s not unusual to have to send claims multiple times before it’s accepted. Payment is not guaranteed. Some claims will be denied. The time you spend on massage billing is not billable time.
Can you accept less than your full rate? It’s possible that all or part of your claim will be denied. If that happens, you’ll receive less than what you billed for. It’s up to you to bill your patient for the remaining balance.
Finally, are you treating patients who have prescriptions for massage therapy? Massage therapists are not licensed to diagnose or prescribe. This means massage therapy must be prescribed by a MD, DO, or chiropractor to qualify.
Everything you need to bill insurance
Before you can bill insurance for massage therapy, you need all of the following:
- License to practice massage therapy
- National Provider Identifier (NPI)
If you don’t have an NPI, you can get one here.
- Rx for treatment
- CPT Codes
Gather all of this before you begin the massage billing process. Keep accurate SOAP Notes. You may be required to submit additional treatment information. Here are some examples of SOAP Notes for massage therapy.
Common CPT codes for massage billing
Current Procedural Terminology codes, or CPT codes, are used by insurance providers to document medical procedures. Use these codes to explain the treatment you provide when you bill insurance for your services.
There are the 3 most common codes used for massage billing:
97124 Massage Therapy
This code is used to describe effleurage, petrissage and/or tapotement. It encompasses most general massage techniques. Billed in 15-minute increments.
97140 Manual Therapy
This code is used to describe hands-on therapies like manual traction, manual lymph drainage, passive range of motion, soft tissue and joint mobilization. Billed in 15-minute increments.
97010 Hot/Cold Packs
This code is used to describe the application of moist heat and/or cryotherapy.
Don’t be confused by these codes. They apply to physical therapy, NOT massage therapy.
You may have advanced training and provide services similar to what these codes provide. However, using these codes for massage therapy treatment will likely end in delays or denial.
97112 Neuromuscular Re-Education
This code is used to describe somatic education. This included neuromuscular re-education of balance, movement, posture and proprioception. This does not include neuromuscular therapy. Use code 97140 for neuromuscular therapy.
97110 Therapeutic Exercise
This code describes exercises that develop strength, endurance, and flexibility facilitated by a licensed healthcare provider. Massage therapists don’t typically qualify as an appropriate provider of this service.
Ways to avoid delays and denial
Delays and denials are a normal part of massage billing. However, there are things you can do to minimize that as much as possible.
- Determine your patients' eligibility BEFORE their session. You can avoid a lot of trouble by verifying your patient's insurance eligibility before treatment.
- Make sure your patient has a prescription for massage therapy. In most cases, massage therapy must be prescribed by a doctor for it to be eligible. Get the Rx from your patient or their provider before treatment.
- Don’t use too many codes. It’s common to do both massage and manual therapy in a single session. However, using codes 97124 and 97140 when billing for the same treatment may get your claim rejected. Also, you may not be able to bill for hot/cold therapy separately because it’s often bundled in with 97124 and 97140.
- Don’t schedule massage sessions the same day they see another provider. If another healthcare provider bills for the same treatment on the same day, your claim will be denied. This could happen if your client sees their chiropractor the same day they see you. The chiropractor may use code 97140 or 97010. While massage therapy works well in conjunction with chiropractic, there is some overlap in treatment. Avoid massage billing issues by scheduling your massage session the day before or after chiropractic care.
Patient reimbursement is the BEST alternative to massage billing
Now that you know what’s involved in massage billing, you may be wondering if it’s worth the effort. The answer to that question depends on your circumstances. If you don’t have administrative staff you can delegate this task to, it might be too time-consuming.
Accepting insurance can be lucrative, but it can also be risky. You don’t get paid upfront. There’s no guarantee insurance will pay. If they don’t, it’s up to you to collect payment from your clients.
If that sounds like too much to take on, there’s an alternative.
Insurance might still pay for your services, even if you don’t bill them for it. It’s possible your client's insurance provider will reimburse them for payments made to you.
Here’s how that works.
1. A client comes in with a prescription from their doctor for massage therapy.
2. You treat them accordingly.
3. You give them an invoice for massage therapy, detailing their treatment.
4. The client pays you at the time of service.
5. Then they submit that invoice to their insurance provider.
6. Their insurance provider reimburses them for the payment they made to you.
This is commonplace for both health insurance and auto insurance claims.
The best part of this strategy is you get paid right away, regardless of the claim status.