I am trying to draw the line between what a massage therapist working in a physician's office can bill for (i.e. specific cpt codes) versus me, a PT in private practice. Specifically in regards to Medicare.
The physician is a friend of mine. She wants to maximize productivity--and I want to help her--but without stepping on my toes. She will refer out what ever her LMT or she herself can not do. Currently they perform Estim, Ultrasound, and Ionto with Dex.
They are not trained to adequately perform therapeutic activity, exercise, or neuro re-ed.
She will be a great referral source for me if I can delineate things a little. We are in Florida.
Joined: November 11, 2002
From: colorado usa
This one is easy...Medicare does not pay for massage period. Any "therapy" billed out must be performed by a licensed physical therapist. Even work performed by aids and massage therapists in your clinic cannot be billed for unless provided under the direct supervision of a physical therapist...legally that is....that is my interpretation...97124 is massage therapy code, and medicare does not pay it. They pay for 97140 (manual therapy)in the cases above....any direct treatment code, has to be performed by a PT...
More than that, the MT can only be used as a tech, that is to say that the PT must either supervise the MT and bill group codes for evertything that the PT and the MT do, or write off everything the MT does.
There are allowances, however, for the MT to do massages and simply bill the client.
[QUOTE]Originally posted by coloradojulie: This one is easy...Medicare does not pay for massage period. Any "therapy" billed out must be performed by a licensed physical therapist. Even work performed by aids and massage therapists in your clinic cannot be billed for unless provided under the direct supervision of a physical therapist...legally that is....that is my interpretation...97124 is massage therapy code, and medicare does not pay it. They pay for 97140 (manual therapy)in the cases above....any direct treatment code, has to be performed by a PT...[/QUOTE]
According to FloridaMedicare.com "Therapeutic Massage Therapy (CPT code 97124)
Massage is the application of systemic manipulation to the soft tissues of the body for therapeutic purposes. Although various assistive devices and electrical equipment are available for the purpose of delivering massage, use of the hands is considered the most effective method of application, because palpation can be used as an assessment as well as a treatment tool.
Massage therapy, including effleurage, petrissage, and/or tapotement (stroking, compression, percussion) may be considered medically necessary if at least one of the following conditions is present and documented:
the patient has paralyzed musculature contributing to impaired circulation; the patient has excessive fluids in interstitial spaces or joints; the patient has sensitivity of tissues to pressure; the patient has tight muscles resulting in shortening and/or spasticity of affective muscles; the patient has abnormal adherence of tissue to surrounding tissue; the patient requires relaxation in preparation for neuromuscular re-education or therapeutic exercise; or the patient has contractures and decreased range of motion."
Florida Medicare does reimburse for massage. I am surprised to read that any physician staff can perform procedures under the direct supervision of the physician (which is not necessarily a rehab specialist). This is scary.
yes this one is easy, but there is confusion in the ranks.....this info is somewhat clearly spelled out in the medicare manuals...of course your LMRP for your carrier/intermediary is the final law of the land.....
a physician can bill for services "ancillary to the physician services" including the "PT" codes. These services must be performed by the doc(yea right) or someone under the direct supervision of the doc. this someone could be a massage therapist, a plumber, or anyone with a pulse regardless of training.
97124 IS reimbursed by medicare as long as it(and any other code/procedure used) is part of a skilled POC aimed at improving/restoring the pateints function. 97140 is used much more often because the CPT definitions of the two are quite similar with respect to soft tissue mobilization and 97140 pays better. (i realize 97140 is more comprehensive)
as with any intervention/procedure, including massage, if the procedure is not medically necesary or part of a skilled treatment plan then it cannot be billed to medicare.
work performed by aides and massage therapists(this is redundant, anyone other than a PT or PTA is an aide) in a PT clinic cannot be billed to medicare PERIOD. ask healthsouth, they're learning.
[This message has been edited by mato_tom (edited June 21, 2003).]