Every medical treatment has a Current Procedural Terminology (CPT) code when evaluated and input into an insurance company’s system. CPT codes included in a customer’s policy will be approved for coverage, and excluded CPT codes will be denied. This can cause some trouble for similar therapies with similar CPT codes but greatly different treatment purposes.
A common example of CPT code mix-ups is manual therapy (CPT 97140) and massage therapy (97124). Some professionals in insurance, billing, and medical industries inadvertently switch one code for the other due to the closely related treatments. However, other insurance companies intentionally code manual therapy as massage therapy since it is easy to deny coverage for massages, which can be misconstrued as a recreational treatment, not a medically necessary one.
CPT Codebook Definitions of Manual & Massage Therapy
97140 Manual Therapy: The CPT Codebook considers manual therapy to be specialized techniques mobilization, joint manipulation, manual lymphatic drainage, manual traction, myofascial release, etc. that are performed on one or more body part for at least 15 minutes each.
97124 Massage Therapy: The CPT Codebook considers massage therapy to be a number of specific techniques, like effleurage, petrissage, and/or tapotement methods like stroking, compression, percussion.
How to Avoid Denials for 97140 Manual Therapy?
Making certain you get the insurance coverage you need for manual therapy falls mostly upon your medical provider. At the same time, there are things you can do to help avoid confusion and unintentional denials.
Three situations that can lead to unintentional manual therapy coverage denials are:
- Incomplete notes: Make sure notes and bills from your medical provider do not include the word massage if you did not get a massage treatment. When Florida’s PIP law changed in 2013 to exclude payments for massage therapy, every doctor in Florida stopped billing 97124 massage therapy. Insurance companies noticed the rapid trend of increased 97140 billings and got wary. Some doctors never updated their forms, reported they performed massage therapy, but billing for manual therapy. This is a huge problem for that medical provider, as it constitutes insurance fraud.
- Unclear communications: Get clear explanations of the therapy performed from your medical provider so you can communicate it correctly with your insurance company, if needed. While you are face-down during manual therapy, it can be impossible to actually know what sort of treatment is being performed, so you need to know it directly from your doctor. Your medical provider should already be making it clear that they are performing manual therapy, not a massage, to protect themselves from insurance fraud accusations later.
- Lack of information: If you are a medical provider, educate yourself and your staff about the differences between manual therapy and massage therapy. Insurance companies will depose doctors in a PIP suit, or as part of a personal injury case. There thousands of different techniques of manual therapy, as aforementioned. Be specific in your notes about which techniques you performed on your patient. As a patient yourself worried about an insurance denial, note what your medical provider includes on medical forms and research what it was to make certain you did receive manual therapy, not massage therapy.
Better Notes for Manual Therapy Records & Billing
Some examples of manual therapy notes that resist insurance denials:
- Manual therapy in the form of soft tissue mobilization was performed on the <include specific areas of the patient’s body> region(s) for X minutes.
- Manual therapy in the form of trigger point therapy was performed on the <include specific areas of the patient’s body> region(s) for X minutes.
- Manual therapy in the form of manual traction was performed on the <include specific areas of the patient’s body> for X minutes.
- Manual therapy in the form of myofascial release was performed on the <include specific areas of the patient’s body> region(s) for X minutes.
Questions About Manual & Massage Therapy Code Mix-Ups? Call 1-855-875-0854
If an insurance carrier denied your manual therapy codes and claimed you really performed massage therapy, our Boca Raton PIP suit attorneys at Ovadia Law Group can help you get paid. We have encountered cases already in which Progressive and other major insurance groups have wrongfully denied manual therapy by claiming it is massage therapy. We can also represent individuals in serious injury claims, like car accidents.
Would you like to know more? Contact our law firm at your first opportunity.
