Maximizing Insurance Reimbursement For Massage Therapy: A Guide To Efficient Billing

Billing insurance for massage therapy can be a complicated process. It requires careful consideration of the benefits and drawbacks, knowledge of the relevant CPT codes, and an understanding of the specific requirements and regulations in your state or region. In this introductory guide, we will explore the key aspects of billing insurance for massage therapy, including the potential advantages and disadvantages, the importance of accurate billing, and the steps you need to take to get started. By the end of this guide, you should have a clearer understanding of whether billing insurance is a viable option for your massage therapy practice and the next steps to take if it is.

Understanding CPT codes

CPT stands for Current Procedural Terminology. The American Medical Association (AMA) manages the oversight of the codes that give definition and structure to the procedures and services performed by physicians and health care providers across the country. CPT codes are used by insurance providers to document medical procedures.

CPT codes for massage therapy include:

• CPT Code 97124 Massage Therapy: Describes work including effleurage, petrissage, and/or tapotement (stroking, compression, percussion) for every 15 minutes.
• CPT Code 97140 Manual Therapy: Includes therapy techniques, consisting of but not limited to connective tissue massage, joint mobilization and manipulation, manual traction, passive range of motion, soft tissue mobilization and manipulation, and therapeutic massage for every 15 minutes.
• CPT Code 97112 Neuromuscular Re-education: Entails the re-education of movement, balance, coordination, kinesthetic sense, posture, and proprioception in 15-minute intervals; examples include PNF (proprioceptive neuromuscular facilitation), Feldenkreis, Bobath, BAP’s Boards, and de-sensitization methods.
• CPT Codes 97010 Hot/Cold Packs: Describes the application of moist heat or cryotherapy for relaxing muscle spasticity, promotion of vasodilation, increasing lymph flow, or other situations.
• CPT Codes 97110 Therapeutic Exercise: Use this code 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 is important to note that these codes are updated periodically, so it is essential to stay up to date with new codes to facilitate claims processing and reimbursement.

Knowing when insurance billing is right for your business

There are several factors to consider when deciding whether to offer insurance billing to your massage therapy clients. Here are some key points to help you determine if insurance billing is the right choice for your business:

Pros of Insurance Billing for Massage Therapy

• Increased accessibility for clients: Offering insurance billing can make massage therapy more accessible to clients who may not be able to afford it otherwise. This can lead to an increase in clients and traffic for your business.
• Affordability for clients: Insurance coverage can make massage therapy more affordable for your clients, especially those with financial constraints.
• Reimbursement: You can get reimbursed by insurance companies for the services you provide, which can increase your revenue.
• Expansion of client base: By accepting insurance, you may be able to offer your services to a wider range of clients, including those who may not typically seek out massage therapy due to financial constraints.

Cons of Insurance Billing for Massage Therapy

• Time and paperwork: Billing insurance can be time-consuming and requires a significant amount of paperwork, including diagnostic codes, billing codes, forms, record-keeping, and more. This can create extra work for you and your staff.
• Potential delays and denials: There is a chance that your insurance claims may be delayed or denied, and payment is not always guaranteed. You may need to send claims multiple times before they are accepted.
• Prescription requirement: In most cases, clients will need a prescription or referral from their primary care physician or a pre-authorization from their insurance company to be eligible for reimbursement. This adds an extra step for your clients, and you may need to guide them through these complicated processes.
• Classification as a healthcare practitioner: In some states, massage therapists are classified as healthcare practitioners (HCPs), which may be a requirement to bill insurance companies. Check with your state's licensing board to determine your classification.
• Additional staff or outsourcing: The complexity and time commitment of insurance billing may require you to hire additional staff or outsource the process to a third-party company, which can increase your costs.
• Revenue considerations: There is a possibility that your claim may be partially or fully denied, resulting in reduced revenue. You will need to bill your patient for any remaining balance not covered by insurance.
• Diagnostic codes: As a massage therapist, you are not licensed to diagnose medical conditions. Therefore, you will need to rely on the diagnosis provided by the client's primary care physician, and you may encounter diagnostic codes that are outside your scope of practice.

Factors to Consider

When deciding whether to offer insurance billing, carefully weigh the pros and cons and consider the following factors:

• The time and resources you can dedicate to insurance billing, including any additional staff or outsourcing requirements.
• The potential increase in revenue and client base versus the possibility of delayed or denied claims and reduced revenue.
• The classification of massage therapists in your state and the specific requirements for billing insurance.
• The willingness of your clients to navigate the process of obtaining prescriptions, referrals, and pre-authorizations.
• The complexity of diagnostic and billing codes, and your ability to keep accurate and extensive records.

Remember, the decision to offer insurance billing depends on your specific circumstances, and there is no one-size-fits-all answer. Carefully evaluate your business needs, resources, and client base to make an informed decision.

What to do when a claim is denied

Even if you do everything right, there is always a possibility that your insurance claim could be denied. If this happens, don't panic. There are steps you can take to appeal the decision and get the coverage you need. Here are some things to keep in mind if your massage therapy insurance claim is denied:

• Understand the reason for the denial: Read the denial letter carefully to understand why your claim was denied. Common reasons for denial include lack of coverage, lapsed policy, failure to notify the insurer in time, or issues with the claim itself.
• Gather evidence: Collect all relevant documentation, such as medical records, police reports, eyewitness information, photographs, and other supporting evidence. This information will be crucial when appealing the decision.
• Contact the insurance company: Reach out to the insurance company and ask for a detailed explanation of the denial. Ask for specific policy language and statutes that support their decision. If they refuse to provide a written explanation, document your request and their refusal.
• Consider hiring an attorney: If you feel the denial was unjustified, consider seeking legal assistance. An attorney can review your case, help gather evidence, and draft a demand letter to the insurance company. They can also advise you on the best course of action, such as filing an appeal or a lawsuit.
• Appeal the decision: If you have grounds for an appeal, don't hesitate to do so. Follow the insurance company's formal appeals process, if available, or seek arbitration to resolve the matter.
• File a complaint: If you believe the insurance company is acting in bad faith or engaging in improper claims practices, you can file a complaint with the state department of insurance.
• Seek alternative sources of compensation: If all else fails, remember that you still have options. You can file a personal injury lawsuit against the at-fault party or explore other potential compensation sources, such as your own underinsured motorist coverage.

Remember that each situation is unique, and it's always a good idea to seek professional advice to understand your specific options and rights. Don't be afraid to ask for help and stand up for yourself to get the coverage you deserve.

How to handle the required paperwork

Billing insurance for massage therapy is a complex process that requires careful handling of paperwork to ensure accurate and timely reimbursement. Here are some detailed instructions on how to handle the required paperwork:

• Licensing and Credentials: Before initiating the billing process, ensure you have the necessary credentials, including a license to practice massage therapy and a National Provider Identifier (NPI). Some states may have specific requirements, so it's important to review your state's laws and regulations.
• Client Communication: During the initial contact with your client, discuss rates, payment expectations, and insurance coverage. Ask clients to verify if massage therapy is covered under their specific insurance plan and whether it requires a massage therapist or another specialist.
• CPT Codes: Familiarize yourself with Common Procedural Terminology (CPT) codes relevant to massage therapy. These codes define and structure the procedures and services provided. Examples include CPT Code 97124 for Massage Therapy and CPT Code 97140 for Manual Therapy.
• ICD Codes: While not your responsibility as a massage therapist, it's helpful to understand International Classification of Diseases (ICD) codes. These codes are used by physicians to diagnose and determine the appropriate treatment plan, which may include massage therapy.
• Record Keeping: Maintain accurate and extensive records as health insurance claims are legal documents. Keep photocopies of clients' insurance cards, obtain the primary care provider's prescription or referral document, document pre-approval requests from the insurance company, and retain SOAP (Subjective, Objective, Assessment, Plan) notes.
• HIPAA Compliance: Ensure compliance with the Health Insurance Portability and Accountability Act (HIPAA) and obtain the necessary documentation, such as the client's authorization to release medical information.
• Payment Arrangements: Have a signed statement from the client confirming their responsibility for any services not covered by insurance.
• Outsourcing: Consider outsourcing the billing process to a third-party company specializing in massage therapy billing. This option can save you time and streamline the revenue cycle management, but it will increase your costs.

How to get reimbursed

If you're a massage therapist, getting reimbursed by insurance companies can be a complex and time-consuming process. Here are some detailed steps to help you navigate the process and increase your chances of reimbursement:

• Know the Regulations in Your State: Massage therapy laws vary from state to state. Check with your state's massage practice board to understand the scope of practice and whether massage therapy is eligible for reimbursement.
• Understand Insurance Coverage: Not all insurance plans cover massage therapy. Before providing any services, verify your client's insurance coverage. Ask questions such as: Are there specific conditions that qualify for reimbursement? Is there a deductible or out-of-pocket cost? Is there a maximum amount payable per visit or policy term? Are there limitations on body regions or types of massage covered?
• Get a Prescription: In most cases, massage therapy must be prescribed by a licensed medical doctor, osteopath, chiropractor, or a doctor of osteopathy for it to be eligible for reimbursement. Ask your clients to obtain a prescription and communicate their diagnosis to their doctor to support the need for massage therapy.
• Understand CPT Codes: Familiarize yourself with Current Procedural Terminology (CPT) codes commonly used for massage therapy, such as 97124 (Massage Therapy) and 97140 (Manual Therapy). These codes are updated periodically, so stay informed to facilitate claims processing.
• Maintain Detailed Records: Health insurance claims are legal documents. Keep accurate and comprehensive records, including SOAP (Subjective, Objective, Assessment, Plan) notes, client charts, and insurance information.
• Verify Insurance Eligibility: Before your client's first visit, confirm their insurance eligibility to prevent issues and delays in reimbursement.
• Consider Outsourcing: Billing insurance for massage therapy can be time-consuming and complex. Consider outsourcing this process to a third-party company specializing in massage therapy billing and coding. They can help ensure accurate and timely claims submissions.
• Explore Alternative Options: If insurance reimbursement is not feasible, explore alternative payment methods. These may include accepting HSA/FSA cards, offering discounted packages, superbills, or affiliating with an insurance company to provide discounted rates for clients.

Frequently asked questions