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physician hiring massage therapist
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physician hiring massage therapist - July 14, 2003 12:56:00 PM
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Susan Patashny
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Joined: July 13, 2003
From: Long Beach, New York
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Does anyone know of the legalities of a physician employing a massage therapist to perform manual therapy on their patients, where the physician bills the patient's insurance company, where a PT ,as an independent contractor does the evals and re-evaluations?
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Re: physician hiring massage therapist - August 5, 2003 8:28:00 PM
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PT
Posts: 7
Joined: June 24, 2001
From: Sacramento, California, USA
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Is the physician billing the massage therapist's treatment as PT? I think that only PTs or PTAs can bill for PT. The setup sound fishy to me.
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Re: physician hiring massage therapist - August 7, 2003 10:08:00 PM
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goodlooks58
Posts: 418
Joined: October 21, 2002
From: CA
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This sounds and smells fishy! You need to reort this to your local chapter or to the Consumers affairs.
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Re: physician hiring massage therapist - March 10, 2004 1:06:00 PM
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mato_tom
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old thread rejuvenated....hopefully everyone knows by now that this is perfectly legal.....the only responsibility of the PT is to document the transfer of care back to the physician......to avoid violating a state practice act limiting who the PT can delegate tx to.............perfectly fine scenario...makes you feel great about PT huh?
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Re: physician hiring massage therapist - May 7, 2004 11:40:00 AM
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durst mary
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From: audubon nj usa
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i am a licensed Massage therapist working in a Chiropractic office in Pa and my doctors office bills insurience under my name and license to insurience companies and it is pefectly legal to do so as the insurience companies pay me.
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mary durst lmt/ma
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Re: physician hiring massage therapist - May 7, 2004 1:48:00 PM
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Andrew M. Ball PT PhD
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Joined: July 28, 2002
From: Charlotte, NC
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As long as all they are billing is massage, there isn't a problem with what Ms. Durst contends. Too often, however, overzealous LMT's try to bill the physical therapy evaluation code (97001), therapeutic exercise (97110), or neuromuscular re-education of movement (97112) for their services.
Neither 97001, nor 97110 is within the scope of massage therapy practice, and to conduct these services and/or to bill such codes as an LMT is clearly fraudulant. 97112 is a bit trickier. I use it for abdominal stabilization training, for McConnell patellar tracking training, and for neurodevelopmental therapy. I SUPPOSE that an LMT could argue that massage yields postural re-training --- but without the ability to follow it up with any strengthening or functional activity, that's a bit of a stretch.
If working as a technician for a chiropractor, it is legal in some states for a chiropractor to delegate some responsibilities to a subordinate tech --- if this is the case, however, the chiropractor must bill under his/her chiropractic license. Legally, however, the DC cannot delegate any more services to the LMT than he could a high school student trained under his or her "expert training."
Dr. Andrew M. Ball
Physical Therapist
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Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: physician hiring massage therapist - May 11, 2004 4:35:00 PM
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durst mary
Posts: 7
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From: audubon nj usa
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DR Ball,
I'm not saying that the doctor is billing for a nonqualified person or highschool twit as you sujjest to do therapy . In close to thirty states Massage therapists who are licensed can bill for postrial retraining or fuctional activaty if we have the training via post school ceu seminars etc then we are allowed if that was included in our state licensing
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mary durst lmt/ma
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Re: physician hiring massage therapist - May 11, 2004 10:39:00 PM
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goodlooks58
Posts: 418
Joined: October 21, 2002
From: CA
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First the ATCs then the chiros and now the LMTs! PTs are the big loosers unless they wake up and smell the stench.
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Re: physician hiring massage therapist - May 12, 2004 5:50:00 PM
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Andrew M. Ball PT PhD
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From: Charlotte, NC
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Assuming that 9 months to 18 months of after high-school education compares with 4 at the BS level plus at least another 2 at the MPT level if not 3 at the DPT level --- AND assuming that biomechanics, kinesiology, exercise muscle physiology, neuroanatomy, neurophysiology, etc. etc. can be taught over a few weekends of continuing education training --- all of that withstanding . . .
How exactly can an LMT execute lasting functional retraining without engaging in exercise prescription, or therapeutic functional activity . . . neither of which are permitted without violation of practice law?
Drew
_____________________________
Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: physician hiring massage therapist - May 12, 2004 8:39:00 PM
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coloradojulie
Posts: 413
Joined: November 10, 2002
From: colorado usa
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My understanding is that the codes Andrew mentioned as well as 97140 can only be used by PTs and in some cases chiros. Also in our state, only treatment administered DIRECTLY by a PT can be billed as such...according to Medicare. We cannot bill for treatment provided by aids (we don't use any anyhow). Massage therapy we do use is coded as 97124...97140 is overcoding and overrepresents the skill of the massage therapist...especially since it is such an all encompassing code.
Perhaps this issue is why more and more insurance companies are not paying for 97124. I think the doc might be on thin ice if he is billing 97140 (which is a direct contact PT code).
You PTs out their in private practice start educating your local public about PT! Remember if that doc is representing the massage therapist as providing physical therapy or people think he/she is a physical therapist...that is illegal. In CO for example, only PTs and chiros (unfortunately), and med docs can use the term physical therapy...no one else.
You may have this doc on practice act violations in you state...as well as the massage therapist if they are licensed in your state.
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PRC
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Re: physician hiring massage therapist - May 13, 2004 3:01:00 AM
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SJBird55
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From: Michigan
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Mary, just because an insurance pays for you, a licensed massage therapist, doesn't mean it is perfectly legal. Reimbursement and legal issues are two different things.
As Drew mentioned, I honestly can't believe that you would think that a continuing ed course here or there would allow you to have the training necessary to do anything functional with a patient.
Colorado, by definition of all the rehab codes, aren't they only to be used by a physician or a therapist? I know chiropractors use them too - but I haven't read all the fine print to know if chiropractors fall under the "physician" definition.
Mary, using those codes as a licensed massage therapist is no problem until you get caught. In my area, the massage therapist capture out of pocket payment for services. I'm not aware of a massage therapist on staff with physicians or rehab clinics. There are quite a few on staff at the manufacturing companies though - and the manufacturing companies are paying them... and I've also had patients tell me who work in large offices that once a week a massage therapist comes to the office and does 15 minute sessions. Maybe my area is a bit more creative? I don't know.
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Re: physician hiring massage therapist - May 13, 2004 8:23:00 PM
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coloradojulie
Posts: 413
Joined: November 10, 2002
From: colorado usa
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In our state, chiropractors fall under the category of practitioners who can use the term physical therapy and therefore bill using these codes.
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Re: physician hiring massage therapist - May 15, 2004 12:47:00 PM
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hmgross
Posts: 286
Joined: February 28, 2003
From: Minnesota
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Sometimes no matter how much you educate people on what PT is, it doesn't seem to sink in. I recently put my right hand on "hiatus" (chronic tendonitis index finger, early OA)for a short time and had it in a functional hand splint. I was surprised by how many people asked me "how are you going to do massage" even though I tell people all the time that I perform specific soft tissue and joint mobilization and not "massage"--a bit maddening at times but we need to keep getting the message out there. Anybody have suggestions on how I can modify some of the Mulligan techniques for the spine, the one where you have to make the "v" with your thumb and index finger? I am so clumsy with my left hand.
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Holly Gross PT
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Re: physician hiring massage therapist - May 15, 2004 1:04:00 PM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
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HMgross,
Having recently moved into orthopedics from pediatrics, I'm feeling as though I have two "left hands" most of the time.
My Mulligan abilities are shoulder specific and a few upper thoracic only, and quite novice at that . . . that said, like when I learned NDT handling, I'm making a concerted effort to approach the patient from either the right or the left, so as to become more amibDex. It made a lot of sense with respect to peds and motor control/neuro kind of patients where in order to be a good therapist one must approach the patient from THEIR side of comfort, not that of your own.
For me, that's translated to attempting manual techniques in much the same way (which looks kind of silly sometimes when doing MWM stuff . . .). It's more of a philosophical issue than a clinical/practical one when it comes to orthopedics, except when (as in your case), you become injured and have to rely more then you'd like to your non-dom side.
As such, I'd suggest you view your challenge as an opportunity for clinical growth, and challenge others to consider trying it as well.
Drew
_____________________________
Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: physician hiring massage therapist - May 15, 2004 4:23:00 PM
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goodlooks58
Posts: 418
Joined: October 21, 2002
From: CA
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Hmgross: Can a new grad read the Brian Mulligan book and utilize basic techniques in treatment? Appreciate an answer from the PTs who are utilizing Mulligan techniques.
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Re: physician hiring massage therapist - May 16, 2004 7:58:00 AM
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hmgross
Posts: 286
Joined: February 28, 2003
From: Minnesota
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Drew, thanks for your reply, I will need both hands for at least 20 more years on the job, so your suggestions are appreciated. Goodlooks-- I would suggest going to a Mulligan course because of the lab and feedback you can get from PTs who have been utilizing the technique. I do a mixed bag of manual therapy techniques, depending on dx, size of the patient, their ability to move/participate etc.
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Holly Gross PT
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Re: physician hiring massage therapist - February 7, 2005 9:23:00 AM
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JLS_PT_OCS
Posts: 1684
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From: USA
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A good look at the ongoing scope of practice controversies...
Yet another reason to continue to support outcomes research in our profession.
I think it is important to make a determination between "Medical Care" and "Personal Services".
I would argue that medical care involves a trained medical professional providing care proven successful through outcomes research.
In the absence of evidence, an individual such as a massage therapist seems to be providing personal services. That's not bad or wrong, but it's bad business for any insurance company to consider that medical care. Looking at the ads in the yellow pages for massage therapy, it seems that there are very few of them claiming to provide medical treatment, which is as it should be.
If massage is medical treatment, then I ought to be getting some right now, paid by my (notional) insurance company. Who wouldn't want a free massage? :)
This is part of what makes medical care so expensive, that many people charge and bill medical treatment codes for what is essentially a personal service.
And certainly, if an LMT's treatment is billed under the term Physical Therapy or PT codes, should be illegal (is in most states) and definitely is disingenous toward the patient and their well-meaning insurance company.
Licensure of LMTs doesn't seem to serve a useful purpose - they don't provide medical care, so licensure only serves to make the state rich and does not demonstrably protect the public from anything. I don't have anything against LMTs, and the absence of licensure requirements would make it easier for anyone to enter the field, which is certainly more fair, since going to "massage therapy school" teaches you a set of skills and does not provide a medical education.
Certainly it is a set of skills in good demand, as I can attest, I've been seen by an LMT once, and he was great! But he didn't claim to be providing medical care.
Anyone should have a right to go to school, learn a skill, and make some money in a business. I don't begrudge the LMTs that. But if you call it(and bill it as) medical care, there's a whole can of worms opened up...
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: physician hiring massage therapist - February 8, 2005 9:02:00 AM
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dosrinc
Posts: 335
Joined: December 9, 2004
From: Bonita Springs
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Unfortunately, if a service is performed in a physicians office and is considered an "incident to" service as physical therapy is, it can be performed by just about anyone, licensed or not.
Fortunately, Medicare has recently ruled that they will not cover physical therapy services "incident to" a physcian unless said PT is performed by a licensed Physical Therapist or Physical Therapist Assistant. Let's hope that the other insurance companies follow Medicare's lead.
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Re: physician hiring massage therapist - February 8, 2005 9:21:00 AM
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JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
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Yes, agreed.
Good point, Rick.
It would seem you have to be a physician to get away with calling anything "incident to" a medical therapy.
In MDs we trust, all others must fight for practice scope and prove their interventions....
Interesting situation...
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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