Massage Therapy: Billing Auto Insurance, Simplified

Massage therapy can be an effective treatment for soft tissue injuries caused by auto accidents. However, the billing process for this type of service can be complex and time-consuming. In some cases, auto insurance may cover the cost of massage therapy if the policy includes Personal Injury Protection (PIP) or similar coverage. This typically applies when the insured individual is at fault for the accident, but it can also apply in no-fault states or when another driver is at fault. It is important to review the specific insurance plan and understand the scope of practice in the relevant state to determine if massage therapy services are covered. Additionally, it is recommended to confirm eligibility and understand the billing codes and procedures to avoid delays or denials of insurance claims.

Confirming client insurance eligibility

Understand State Licensing Requirements:

Each state has its own licensing requirements for massage therapists, which can impact your ability to bill insurance. Familiarize yourself with the specific regulations in your state, including any background checks, minimum education or training hours, and exams that you need to fulfil. Staying compliant with state laws is essential for maintaining your credibility and avoiding legal issues.

Complete the Insurance Credentialing Process:

The insurance credentialing process allows you to contract directly with insurance companies as a recognized provider. This process typically involves an evaluation of your background, license, education, and training history. It can take at least three months to complete, and the specific requirements may vary depending on your state. Compile a list of desired insurance companies, assemble the necessary documents, complete their applications, and submit them accordingly.

Understand CPT and ICD Billing Codes:

Familiarize yourself with CPT (Current Procedural Terminology) and ICD (International Classification of Diseases) billing codes relevant to massage therapy. CPT codes specifically identify the procedures and modalities used during massage services, while ICD codes categorize diseases and health conditions treated by massage therapy. Accurate usage of these codes is essential for proper reimbursement and maintaining relationships with insurance companies.

Communicate Effectively with Clients:

Clear and transparent communication with clients about their insurance coverage is vital. Educate your clients on their benefits, set the right expectations, and address any questions or concerns they may have. Provide comprehensive information to empower them to make well-informed decisions about their healthcare and avoid unexpected financial burdens.

Verify Insurance Coverage:

Encourage your clients to verify their insurance coverage for massage therapy. They can do this by contacting a representative from their insurance company, usually through the customer service number on their insurance card. It is essential to understand the specific requirements, limitations, and conditions of their insurance plan regarding massage therapy services.

Obtain Necessary Referrals and Prescriptions:

Doctor referrals and prescriptions are often necessary when billing insurance companies, especially for occupational injuries, automobile accidents, or workers' compensation claims. Ensure that your clients have the proper referrals and prescriptions in place to avoid billing issues and guarantee optimal coverage.

Maintain Precise Documentation:

Accurate and comprehensive record-keeping is crucial for successful insurance billing. Treatment notes should include the date and duration of the session, specific areas of focus, a description of the patient's condition, and their progress and response to treatment. This documentation assists insurance companies in understanding the medical necessity of the services provided and facilitates the claims process.

CPT codes for massage therapy

CPT stands for Current Procedural Terminology, and these codes are used by insurance providers to document medical procedures. CPT codes are managed by the American Medical Association (AMA), which maintains oversight of the codes to give definition and structure to the procedures and services performed by healthcare providers across the country.

CPT codes commonly used by massage therapists include:

• CPT Code 97124 (Massage Therapy): This code describes massage techniques such as effleurage, petrissage, and/or tapotement (stroking, compression, percussion) for every 15 minutes of treatment. It is a time-based code, billed in 15-minute increments.
• CPT Code 97140 (Manual Therapy): This code covers manual therapy techniques, including connective tissue massage, joint mobilisation and manipulation, manual traction, passive range of motion, soft tissue mobilisation and manipulation, and therapeutic massage. Like CPT Code 97124, it is billed in 15-minute increments.
• CPT Code 97112 (Neuromuscular Re-education): This code is used for the re-education of movement, balance, coordination, kinesthetic sense, posture, and proprioception in 15-minute intervals.
• CPT Code 97010 (Hot/Cold Packs): This code describes the application of moist heat or cryotherapy to relax muscle spasticity, promote vasodilation, increase lymph flow, or in other situations.
• CPT Code 97110 (Therapeutic Exercise): This code is used for therapeutic exercises applied to a single or multiple body parts to develop strength, endurance, range of motion, and flexibility within 15-minute intervals.

It's important to note that these codes are updated periodically, so staying informed about any changes can help facilitate claims processing and reimbursement.

Insurance reimbursement

Weigh the Benefits and Risks

There are several advantages to accepting insurance reimbursement for massage therapy. It can make your services more accessible and affordable for clients, potentially increasing your client base. It can also provide a steady stream of income, even when you are not working, and help you build relationships with other healthcare providers. Additionally, it contributes to the acceptance of massage therapy as an effective healing tool in the medical community.

However, there are also some challenges to consider. The reimbursement process can be time-consuming and require a lot of paperwork. There may be delays in payment, and you will need to keep up with changing CPT (Current Procedural Terminology) codes. It is important to note that not all massage therapy services are covered by insurance, and each insurance company and plan has its own guidelines.

Understand State Laws and Insurance Plan Policies

Before accepting insurance reimbursement, it is crucial to understand the scope of practice in your state and the specific policies of the insurance plans you intend to bill. A license to practice massage therapy in your state does not guarantee that insurance companies will accept reimbursement claims. It is your responsibility to ensure that massage therapy services provided by a state-licensed massage therapist are covered by your client's insurance plan.

Discuss Rates and Payment Expectations

It is important to have open and honest discussions with your clients about rates and payment expectations from the initial contact. Be transparent about whether massage therapy is a covered service under their insurance plan and if there are any specific requirements, such as the need for a prescription or a referral from another healthcare provider.

Collect and Retain Necessary Information

To make an insurance claim, you will need to collect and retain supporting documentation. At a minimum, you will need to provide documentation confirming that the service was provided. In most cases, insurance companies will also require a doctor's order for the service before paying a claim. Familiarize yourself with the requirements of the insurance companies you plan to work with.

Stay Up-to-Date with CPT Codes

CPT codes are periodically updated, so it is important to stay informed about any changes or additions. Commonly used CPT codes for massage therapy include:

• CPT Code 97124 (Massage Therapy)
• CPT Code 97140 (Manual Therapy)
• CPT Code 97112 (Neuromuscular Re-education)
• CPT Codes 97010 (Hot/Cold Packs)
• CPT Codes 97110 (Therapeutic Exercise)

Consider Using a Billing Company

If the insurance billing process seems daunting, you can engage the services of companies that specialize in handling insurance billing for a fee or a percentage of the invoice. This can save you time and ensure that your claims are processed correctly.

Auto accident claims

Massage therapy can be an effective treatment for soft tissue injuries sustained in a car accident, such as whiplash, neck and back injuries, and muscle pain. It can aid recovery by restoring balance to the nervous system and promoting blood circulation, thereby reducing swelling and aiding tissue recovery.

If you've been injured in a car accident, your auto insurance may cover the cost of massage therapy as part of your medical treatment. This is especially relevant if you have Personal Injury Protection (PIP) or medical payments coverage in your policy. PIP insurance is available in 12 states and covers medical expenses resulting from an auto accident, regardless of who is at fault. In Oregon, for instance, PIP coverage must include massage therapy services with no co-payment required.

However, it's important to note that auto insurance companies may hesitate to cover massage therapy due to the prevalence of insurance fraud. They may require proof that the treatment is “medically necessary” and “reasonable” for your recovery. To increase the likelihood of coverage, you should obtain a prescription or referral from your doctor, specifically mentioning massage therapy, and ensure that your massage therapist is licensed and accepted by your insurance provider.

To bill auto insurance for massage therapy, you may need to submit a claim with detailed documentation, including a prescription from your doctor and evidence of the therapy's medical necessity. It's recommended to consult with a healthcare provider for proper documentation and a massage therapist who has experience working with auto insurance companies. Additionally, be mindful of the statute of limitations for filing a claim, as it varies by state or jurisdiction.

Personal Injury Protection (PIP) coverage

PIP coverage takes care of medical bills for the policyholder and anyone covered by their policy. This includes passengers in the policyholder's vehicle, even if they don't have their own health insurance. In some states, PIP may also cover non-medical expenses, such as lost wages, household services (like childcare or house cleaning), disability, and even funeral expenses. PIP coverage can be a vital source of financial support when dealing with injuries and their aftermath.

Who Is Covered by PIP?

PIP coverage extends beyond just the policyholder. It also protects anyone covered by the policyholder's policy, including passengers in the vehicle at the time of the accident. Additionally, in some states, PIP may cover family members living in the same household, even if they are not listed on the policy. This aspect of PIP ensures that not only the policyholder but also their loved ones are taken care of in the event of an accident.

PIP coverage comes into effect when individuals covered by the policy experience injuries in a car accident, regardless of who is at fault. This means that whether the policyholder is at fault or not, their medical expenses will be covered up to the limits of their PIP policy. This is particularly important in no-fault states, where each driver's insurance covers their own medical costs, regardless of who caused the accident.

PIP policies have minimum coverage requirements set by state governments and maximum coverage limits set by insurance companies. These limits are usually around $25,000, but they can vary depending on the state and the insurance provider. It's important to review the specific coverage amounts offered by different insurance companies to ensure adequate protection.

Where Is PIP Coverage Mandatory or Optional?

PIP coverage requirements vary across the United States. It is mandatory in 15 states and Puerto Rico, including Delaware, Florida, Hawaii, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, New Jersey, New York, North Dakota, Oregon, Pennsylvania, Utah, and Puerto Rico. In other states, PIP coverage may be optional or not offered at all. It's important to check the specific requirements and options in your state to ensure compliance with insurance regulations.

Personal Injury Protection is distinct from liability insurance, which covers expenses for third parties (such as pedestrians or other drivers) but does not cover the policyholder's own medical costs if they are at fault. PIP is also different from bodily injury liability coverage, which only covers medical expenses for others when the policyholder is at fault. PIP provides broader protection by covering medical costs for both the policyholder and their passengers, regardless of fault.

Frequently asked questions