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Getting insurance to pay for massage therapy

  1. Post Getting insurance to pay for massage therapy
    Medical Coding Books
    I would like to know if anyone has had any experience billing insurance for massage therapy and if so what criteria would you use..

    Thanks for your help..

  2. #2
    Location
    Burling, MA
    Posts
    36
    Default
    Billing massage therapy can be tricky and is based on payer rules. For example, some payers will only pay one modality with a visit or two modalities max. Massage therapy is billed in 15 minute increments but I have never seen more than 1/2 hour get paid by health insurance - in my experience. Be sure patient signs an ABN saying they know they might be liable for payment if insurance denies the therapy.
    In many cases, HMOs tell their patients that massage is a member benefit which entitles them to say, 25% discount on massage therapy and it does not go through insurance. Patient pays at time of service. I know at least 2 HMOs that have that rule.
    So, if you charge $75 for a 50 minute massage, the patient only has to pay out of pocket $56.25....which is cheaper than going to a massage spa.

  3. #3
    Location
    Sioux Falls South Dakota
    Posts
    358
    Default
    When I worked for an insurance company we did not pay for massage therapy except to treat lymphedema post-mastectomy. It was an exclusion, and the patient was liable - we did not make it provider liability. However, you should check with each carrier you want to bill - this is one area that they are not universal on.
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

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