97124 reimbursement

ded1982

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I recently just started at a small chiropractic office who has a massage therapist on staff. They have tried billing out massages using CPT code 97124 but have not been successful in getting it paid by insurance. Does anyone have any input on if this is a possibility to receive reimbursement for this code or is it not a covered procedure code by patient's insurance? The specific patient has Medicare insurance, didn't know if simply medicare won't cover the service but perhaps other insurances might? Any input would be appreciated!
Thanks,
Darcy Griffin
 

CodingKing

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Most insurance won't cover massage therapy codes. So coverage would be on a case by case basis. Medicare does not cover massage therapy.
 

ded1982

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Thanks! Was pretty much how I figured it would work but wanted to check in case I missing something.
 

michellepilcher

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So... this is how I bill massage. I haven't billed it for a chiropractor so I don't know that it's exactly the same.
There's never been an issue getting paid other than it has to be billed under the MD rather than a massage therapist in my state. Yours may be different.

97124 Massage Therapy (Basic Swedish Massage) No insurance is going to pay for this
97140 Manual Therapy (Advanced Massage Therapy Techniques) Most insurance will cover this. (I bill it at 1 unit every 15 minutes).

Medicare does not cover massage. However, if you use a GY modifier you can get the denial from MCR to send to the patient's secondary coverage.
 

ded1982

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Excellent, I will look into this and see if it's something the Dr. wants me to try
 

CodingKing

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Here is a good write up on the difference between Massage and manual therapy

Q: What’s the difference between 97140 and 97124?

A: 97124 is "massage, including effleurage, petrissage and/or tapotement" and 97140 is "manual therapy techniques". Occasionally someone will ask if they can just switch from one code to the other depending on which one gets paid. The answer is no. Two codes would not exist if they were the same thing. If the purpose of the therapy is to promote relaxation and improve circulation, it is massage. If the purpose is to improve function, such as range of motion, then it is manual therapy. Trigger point therapy and myofascial release are examples of manual therapy. Keep in mind that both of these services require the -59 modifier when billed with Chiropractic Manipulative Therapy on the same visit. This means that they were performed in a different region than the adjustment.
 
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Massage Therapy

I recently just started at a small chiropractic office who has a massage therapist on staff. They have tried billing out massages using CPT code 97124 but have not been successful in getting it paid by insurance. Does anyone have any input on if this is a possibility to receive reimbursement for this code or is it not a covered procedure code by patient's insurance? The specific patient has Medicare insurance, didn't know if simply medicare won't cover the service but perhaps other insurances might? Any input would be appreciated!
Thanks,
Darcy Griffin
Massage therapy is covered by most major medical carriers who have physical therapy coverage. You need to use a 59 modifier and ensure you are not going over the number of modalities allowed by the carrier. Medicare does not cover nor does Cigna or Medcost. BCBS does, as does most Aetna policies and some United Health Care. When you do your verification, check the code in the physical therapy section. We have a massage therapist on duty and bill her services daily, successfully.
 

LaurenDeVore

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97124 Allowed by Medicare

Does anyone know why Medicare has an allowed amount on their fee schedule for 97124 if it is a non-covered service? Is this just the amount that you are allowed to balance bill when the proper modifier is used? Thanks!
 
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Does anyone know why Medicare has an allowed amount on their fee schedule for 97124 if it is a non-covered service? Is this just the amount that you are allowed to balance bill when the proper modifier is used? Thanks!
If you are billing this under the Chiropractor the only codes Medicare will cover is the spinal adjustment 98940-98942 code nothing else...not even the extremity adjustment 98943. You will need to have the patient sign a ABN if you want to charge them for any additional services and that would be based on what you charge for massage not what the fee schedule allows. If it is denied you cannot balance bill the patient.
 

LaurenDeVore

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Massage Credentialing

I am not billing under a chiropractor, the massage therapist is on staff in a physical therapy clinic. Blue Cross and Aetna offer coverage for massage in our area so we have two major payors covering massage services. I'm still a bit stymied with both Medicare and Tricare, though. I know it is not a covered service with either of these insurances, but we are in network with both. Does this obligate us to bill both insurances, even though we know it will just be denied as non-covered? If so, are we required to credential the provider with both insurances to get them to process her claims? (We are definitely getting ABNs from all Medicare patients and the equivalent from all Tricare patients).
Thank you in advance for any input.
 
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