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.
There’s no doubt that massage clients would love it if their insurance paid for your services, and for some of them, that’s a real possibility. However, in many cases, massage therapy is not covered by insurance. Here's how to know if massage insurance billing is right for your business.
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.
Before you can bill insurance for massage therapy, you need all of the following:
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.
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. The most common 3 codes are: 97010 Hot/Cold Packs, 97124 Massage Therapy, and 97140 Manual Therapy.
This code is used to describe effleurage, petrissage and/or tapotement. It encompasses most general massage techniques. Billed in 15-minute increments.
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.
This code is used to describe the application of moist heat and/or cryotherapy.
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.
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.
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.
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.
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.
The easiest way to collect a payment would be to request the client pay online via credit card or gift card before the massage therapy appointment so you don't have to chase or bother them for payment. This can be done with massage therapy invoicing software.