Once traditionally seen as a spa treatment, massage therapy has quickly become an established and reputable method of healthcare. Massage therapy is now considered a part of the complementary and alternative field of medicine and is often used to elevate standard treatment by physicians when working with clients with specific conditions and ailments. The latest CDC data shows that 23.5% of adults have had at least one expenditure for a CAM care approach.
As more wellness providers recommend massage therapy services as a compliment to their treatment plants, clients are seeking benefits from their insurance providers to help cover the costs. Receiving reimbursement by insurance payers takes care and communication, both with your clients and the insurance company.
In this article, we help Massage Therapists better navigate insurance reimbursement. Learn how you can help clients better utilize massage therapy covered by insurance.
Verifying Insurance Coverage & Reimbursement for Massage Therapy
At the current time, there is no standard coverage for massage therapy services within large insurance providers. This means getting coverage comes down to the reason for care and how that care is defined to the insurance company. Usually, if the treatment is medically necessary, or it fits the criteria of coverage provided by the insurance company, your client will be covered and you will be reimbursed. Additionally, if the services fit into the category of “habilitative or habilitation treatment,” it may be considered an essential health benefit and your client will receive coverage. Many insurance companies deem massage therapy necessary in the acute phase of treatment, rather than as a long term care procedure.
An easy way to increase your chances of massage therapy being covered by insurance is to ask your clients to obtain a referral from their primary care physician. In a recent survey conducted by the American Massage Therapy Association, 67% of respondents indicated that their primary physician recommended they receive massage therapy. A prescription or referral from a physician is important for reimbursement because massage therapists are not licensed to diagnose medical conditions. With a referral from a doctor, the massage therapist can include the ICD-10 diagnostic code and referring provider on their CMS-1500 form, and increase their chances of reimbursement.
One potential barrier to coverage is provider credentialing. A recent study involving health insurance policies nationwide showed that being credentialed as a massage therapist was not always enough to qualify for reimbursement; certain companies required providers to receive pre-authorization prior to providing services.
Reimbursement can also vary from state to state. All 50 states offer reimbursement for clients who are injured while at work or in a motor vehicle incident. Some states will provide reimbursement for services prescribed by a physician; it’s important to be consistently checking the legislation within your state to ensure you are up to date on what is currently covered.
The best way to ensure massage therapy insurance coverage is to verify your client’s benefits with their insurance provider before providing any services. When verifying their benefits, be sure to ask questions that will get you the clearest understanding of your client’s coverage, such as:
- What are the conditions to qualify for reimbursement?
- Will there be a deductible or any out-of payment cost? (So you can alert clients ahead of time)
- Is there a maximum amount payable per visit or per policy term?
- Am I limited to treating any specific body region?
- Do all types of massage therapy qualify for coverage?
CPT Codes for Massage Therapy
Once you’ve verified that massage therapy coverage is possible, the two main billing CPT codes identified for insurance billing of massage therapy include:
- 97124: Stroking, compression, percussion
- 97140: Manipulation, traction, lymphatic drainage
Code 97124 is more so directed at massage therapy, while 97140 is actually for manual therapy. When billing for either of these two codes, be sure to cite these exact treatment procedures in your claim to ensure coverage. Additionally, do not cite both of these codes when submitting for reimbursement. Insurance companies will not cover services if both of these codes are cited.
Be sure to also have your client’s insurance information & photocopies of their card on file, as well as their chart notes for each session readily available. These will be essential when filling out your CMS-1500 forms for each reimbursement.
What to do If Services Are Not Covered
If you are unable to guarantee coverage or reimbursement from your client’s insurance company for services, you can employ a variety of other payment techniques that may be enticing to clients.
- Accept an HSA/FSA Card
Flex Spending Accounts (FSA) and Health Savings Accounts (HSA) are commonly used bank accounts that employees can set up through an employer to set aside pre-tax money to pay for qualified medical expenses.
By accepting FSA and HSA cards for massage therapy services, you’ll enable your clients to use pre-tax dollars, that they have already set aside for healthcare expenses, to work with you. You will still get paid for your services, but you and your clients can avoid the stress of dealing with insurance companies or having to pay fully out-of-pocket.
- Include services in a package at a discounted rate
While this option still requires a client to pay out-of-pocket for your services, including massage therapy within a package at a discounted rate can help clients who need your services, but are struggling to pay. For example, if you charge $100 per session, you can offer a package of 5 sessions for $425, to make services more accessible to your clients lacking coverage.
This is also a great strategy for keeping your calendar full and ensuring consistent client appointments. With a package, clients are more likely to follow-up sessions, and use all of their credits. They won’t disappear after one or two appointments.
- Offer a Superbill
If clients are willing to pay out-of-pocket rates for your services, you can generate a Superbill for them to try and get coverage from their insurance companies. Superbills are a receipt of your services that clients can submit to their insurance companies in hopes of being reimbursed for their payment. They do not guarantee reimbursement, but they take very little time for you as the provider to put together and may result in a client getting some or all of their payment returned to them by the insurance company.
- Affiliate with an insurance company
In lieu of offering coverage for massage therapy services, some insurance companies allow massage therapists to “affiliate,” with them. This means that, while clients will not get coverage for their services, insurance companies will give them discounted rates for services at certain massage therapy practices. Massage therapists will not be reimbursed by the insurance company, but instead benefit from an increased stream of recommendations to clients by the insurance company.
Healthie for Massage Therapists
Healthie’s all-in-one software helps massage therapists streamline scheduling, billing, note-keeping, and client communication. With features such as:
✔ Insurance billing: Generate CMS-1500 claims that can be batch-downloaded and submitted to your clearinghouse of choice. Easily track claim statuses and reimbursement within Healthie, or invoice clients for non-covered amounts.
✔ EHR: Leverage Healthie’s HIPAA-compliant electronic health record allows you to keep clients’ personal health information secure, and track client progress using custom-built chart notes.
✔ Packages and Invoices: Create custom package offerings and authorize client payments using our integration with Stripe. Generate invoices and receipts for payments.
✔ Online Booking: Healthie’s scheduling feature allows you to create custom appointment types, set availability, and book online via our web platform or mobile app.
✔ Client Engagement: Check in with clients between appointments using Healthie’s HIPAA-compliant chat feature.
Healthie allows you to focus on your clients while knowing your back-office responsibilities are handled.
Learn more about Healthie for massage therapists here.
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