Although many people receive massages for relaxation, some individuals need massage therapy for medical reasons. If you’re interested in working with these clients, then you’ll want to know how medical insurance intersects with the massage industry and massage therapy billing codes.
In this guide, we’ll cover the following topics to help you learn more about accepting insurance and massage therapy billing codes:
Venturing into the medical world can be overwhelming, as there are many rules and regulations that you need to comply with. Let’s look at the basics of massage billing and medical insurance and help you evaluate whether accepting insurance for massage billing is the right move for your practice.
There are many benefits to accepting insurance as a massage therapist, such as:
While accepting medical insurance payments offers many advantages, it also has some downsides, such as:
Ultimately, it’s up to you to determine if the benefits outweigh the costs for your practice. Only you know whether you’d be able to successfully accept medical insurance.
Some massage CPT codes are time-based and billed in 15-minute increments or a “unit.” However, if the treatment duration is not perfectly divisible by 15 minutes, most insurance payers allow you to still bill the unit if it’s over 8 minutes:
No, you cannot bill insurance for a missed appointment or for services not performed. This is considered insurance fraud. If you wish to incentivize clients not to miss their appointments, you can charge a no-show fee and bill it directly to the client.
Payment timelines vary from payer to payer, but generally, if you submit your claim electronically, you can expect it to take between 14–30 days. Paper claims take longer, usually around 60–90 days before payment.
If your claim is denied, it will take even longer, as you’ll need to correct and resubmit your claim and await the payer’s final decision.
While working with insurance has its drawbacks, there’s a way for you to work with clients who need insurance without fronting the risks.
Instead of handling insurance yourself, ask patients to seek reimbursement from their insurance themselves. After you’ve seen a client with a prescription for massage therapy, provide them with a superbill detailing all the treatments they received. The client will pay you for your services and submit that superbill to their insurance provider. The insurance provider will then reimburse the client for the payment they made to you.
Although this strategy still requires additional paperwork, it removes the burden of submitting claims and dealing with insurance providers yourself. It also removes uncertainty around payments, as you’ll get paid either way!
The CPT codes most relevant for massage billing include:
This CPT code describes a therapeutic massage procedure in one or more areas. It includes effleurage, petrissage, and tapotement. This code is time-based and billed in 15-minute increments.
Although this massage billing code is similar to 97140: Manual Therapy, it differs in intent. If you’re trying to increase circulation and tissue relaxation, bill 97124: Massage Therapy.
Insurance providers heavily scrutinize the use of this code and will only cover it when medically necessary. This means massage therapists must take robust SOAP notes and provide rigorous documentation if they plan to bill this CPT code.
This massage therapy billing code describes manual therapy techniques, including mobilization, manipulation, manual lymphatic drainage, and manual traction, in one or more regions. This code is time-based and billed in 15-minute increments.
97140: Manual Therapy describes therapy that increases active pain-free range of motion, increases the extensibility of myofascial tissue, and facilitates the return to functional activities. You can report codes 97124 and 97140 in the same session only if you apply the unique massage techniques to different areas of the patient’s body.
This massage therapy billing code describes the application of any physical agent to produce therapeutic changes to biological tissue. Most commonly, it describes the application of moist heat, cryotherapy, or hydrotherapy. This billing code is not time-based and may be billed only once daily. If your client has received this type of therapy from another medical practitioner, you will not be able to use this code.
This CPT code refers to exercises and activities that are specifically designed to help patients gain better mobility and fitness levels. Normally, these exercises are used on patients with injury-related disabilities, patients who are recovering from surgery, and patients who need relief from pregnancy or osteoporosis. 97110: Therapeutic Exercise is time-based and billed in 15-minute increments.
Although this code is valuable for specific conditions or patients, it was originally designed for use by physical therapists. If you’re not trained or licensed as a physical therapist, your claim will be heavily scrutinized and may be denied.
This massage billing code is used for therapeutic procedures on one or more areas for neuromuscular re-education of movement, balance coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities. It is time-based and billed in 15-minute increments.
Like code 97110: Therapeutic Exercise, 97112: Neuromuscular Re-Education was originally designed for use by physical therapists. If your training and licensure don’t reflect experience as a physical therapist, it may not be worthwhile to bill these codes, as your claim will likely be denied.
In addition to using the correct massage therapy billing codes, you may also need to clarify the intent and activity of your services with a CPT code modifier. Here are two common massage billing modifiers to know:
Double-check that you’re using these massage therapy billing code modifiers in the appropriate situations. Similarly to using incorrect codes, using incorrect modifiers can lead to denied claims.
Timed versus untimed massage therapy billing codes add another layer of complexity to the billing process. We discussed earlier that certain billing codes are timed, such as 97124: Massage Therapy, which is billed in 15-minute increments. If your massage business accepts Medicare patients, you’ll need to learn the nuances between the two.
Let’s break it down a bit further:
As you fill out insurance forms with massage therapy billing codes, know if the code is timed or untimed to ensure you’re accurately reimbursed.
Although coding is a crucial part of the massage billing process, it’s not the only thing you have to consider before billing insurance for your services. Let’s take a look at the massage billing process.
To accept insurance as a massage therapist, you’ll need to meet medical credentialing requirements. Double-check how insurance billing works with your state’s massage practice board and ask them any questions you may have.
Generally, insurance billing requires the following credentials:
After collecting these documents, you’ll begin the credentialing process with various health insurance companies. During this process, you’ll prove that you are a qualified, professional, and trustworthy massage therapist that the insurance company can partner and sign a contract with. This process can take several months, so it’s best to start it as soon as possible.
Review and sign contracts that determine your set reimbursement rates with each insurance payer. These documents tell you the exact amount that you’ll be paid for certain CPT codes, and you cannot start seeing patients until this contract is signed and in effect.
Then, set up everything your massage practice needs to handle massage billing. Typically, this means outlining all your workflows and setting up your billing software or clearinghouse account to submit claims digitally. While you can handle billing manually or by hand, a streamlined tool speeds up the process and makes it easier for everyone involved, including yourself.
At this point, you’re ready to see clients who want to use insurance to pay for their sessions. Before every appointment, check these details to make sure that customers are covered:
If you run into issues verifying any of this information, let your client know before their massage session that you cannot bill their insurance. You can give them the option to either come back once their details are straightened out or pay for the day’s services out of pocket. If they choose the latter option, you can offer them a superbill they can submit to their insurance provider for reimbursement.
Additionally, avoid providing massages on a day when the patient visited another provider. This is because certain massage therapy billing codes have limitations. For example, code 97010: Hot and Cold Pack Therapy can be billed only once per day. That means if your client has received this therapy from another provider on the same day they visit your practice, you may not be able to receive full reimbursement for your massage services.
During your massage session, perform prescribed services to the best of your ability. Ensure that the treatment you provide aligns with the prescribed CPT code to mitigate any issues with coding and scrutiny from insurance providers after the fact.
You’ll also need to take detailed SOAP notes that prove the medical necessity of your services. This means you need to show that the patient has a limitation that the massage is fixing or alleviating, whether it’s pain in their shoulders or difficulty with knee mobility. SOAP notes provide a professional framework that helps you do this.
Invest in a system to collect and store information about the sessions you provide, including your SOAP notes. This makes supporting your payment requests easy, as you can send comprehensive records proving that you provided a legitimate service to your clients.
The final part of the massage billing process is the most complicated, but it can be broken down into the following steps:
Though massage billing is complex, you can facilitate prompt insurance processing by following these steps. Furthermore, robust software can streamline the process.
Accepting insurance as a massage therapist adds extra work to your plate, and you may feel that this extra effort is not worth the benefits. However, before you completely dismiss the idea, consider that the right massage therapy software solution can substantially improve your massage billing processes.
Some helpful massage therapy software features include:
Aside from these specific billing-related benefits, massage therapy software is beneficial for your practice in other ways. These solutions can improve client communication, keep your data organized, and even help you acquire and retain clients. Even if you decide not to accept insurance coverage, consider how massage therapy solutions can streamline your practice’s processes and address your pain points.
Although insurance providers have historically overlooked massage therapy, that attitude is changing, and accepting insurance as a massage therapist is becoming more viable. However, many rules and regulations can make it difficult to add insurance to your massage billing processes. Ultimately, it’s up to you to decide whether it’s worth it for your practice to make the change.
To learn more about running a massage therapy business, explore the following resources: