In our quest to assist massage therapists in entering the world of insurance billing, we’ve had many questions from our readers about insurance billing, Obamacare or the Affordable Care Act, and insurance billing codes. Today we’re going to do a quick tip introduction to massage therapy insurance billing codes and give you a few tips on how to decipher them. To be clear, this is a very general overview for those who are getting started, and more in-depth research on insurance billing codes is necessary to begin the process.
The codes we refer to are actually called CPT codes, which stands for Current Procedural Terminology. CPT codes are the numbers assigned to every task and service a physician or health care provider might perform. It is the standard terminology used to bill for insurance reimbursement. The AMA (American Medical Association) has committees that develop and review the CPT codes.
As health care practices change, the codes change too. There are thousands of codes and they are constantly added to, revised, and discarded. It’s important to know the most current codes and make sure you aren’t using any outdated or discarded codes.
What are some specific CPT Codes that massage therapists can use?
As of this posting (August 2013) these are some of the CPT codes commonly used by massage therapists; some are used more commonly than others.
• CPT Code 97124
• CPT Code 97140
• CPT Code 97112
• CPT Codes 97010
• CPT Codes 97110
Each massage therapist needs to use the code that they are trained in. Technically you shouldn’t just see a code that an insurance company will reimburse for and bill for it. For example, many will bill 97140 (manual therapy) because it pays more but people may not be trained in it specifically.
Look it up
Always refer to newest edition of American Medical Association. CPT, Professional Edition, under the heading of Physical Medicine and Rehabilitation, Modalities and Therapeutic Procedures for further clarification on the codes you need to use, and to make sure they are the most accurate updated codes.
Before billing the insurance company, massage therapists should always:
1. Confirm you are an eligible provider
2. Confirm which codes the company reimburses.
3. Confirm if you need a prescription from a referring doctor (often required to verify medical necessity.)
Massage therapy services are also covered under personal injury protection (PIP) through auto insurance, which is separate from health insurance coverage.
What questions do you have about insurance billing or CPT codes? Let us know in the comments and we can do another quick tip to answer your questions!