So you want to start billing insurance companies. Here is some helpful information that I have learned over the past 14 years of billing insurance companies in Washington State. I have taken classes in most of the 50 states and have heard many different rules that apply in some states and not others.
This is not intended to answer all your questions by no means. It is just a starting point. In most states this applies to Labor and Industry and Auto Insurance Claims only.
Most commonly used CPT coeds for Massage Therapist:
97010 Hot and Cold pack Therapy (Hydro Therapy)
97112 Neuromuscular Therapy
97124 Massage Therapy (Basic Swedish Massage)
97140 Manual Therapy (Advanced Massage Therapy Techniques)
Mixing and matching these codes can get your claim or part of your claim rejected depending on the insurance company and the state you are in.
Now the most important thing to note is that each of these codes is time sensitive and 1 unit = 15 minutes. 97010 can only be used 1 time per day. If a chiropractor, physical therapist or even a doctor has already used this code then you can not. For this reason is best to have your appointments set up on different days from other providers.
The following 2 codes can be used if the doctor in charge gives that privilege by writing something such as "evaluate and treat" on the prescription. If this is written on the prescription/ referral then the Doctor has given you use of his license to evaluate the patient. This would mean that you have gained the Doctors trust. Make sure that you don’t lose that trust. Write a complete and thorough evaluation and if you don’t feel confident in doing so then don’t bill for it.
97001 Office Evaluation (1st Appointment only) This code is not time sensitive set your billing according to the time and detail of the evaluation skills you have.
97002 Office Re-evaluation with new referral/prescription
Two more things that a massage therapist can charge for is:
- Clerical fee’s – (Medical Records)
- Interest for bills outstanding more than 30 days. How much depends on your state.
Now having giving you the basic information of different codes and what you can charge for be aware that this is just a list of the usual codes listed. The CPT codebook does say that no code belongs to any category of provider. You must be competent and within the scope of your licensure. The scope of your licensure varies from state to state.
Note all Codes starting with 99 were written with the intent of being used by Doctors. All codes starting with 97 were written with the intent of being used by physical therapist. Remember the codes I listed above all start with 97 but massage therapist were not in existence at the time the codes were written so you need to look at the detailed code description and make sure that the code description fits within the scope of the licensure for your state.
The last piece of advice I can give you is make sure that you don’t up code. Another words if you don’t have the training and competencies in one of the more advanced techniques don’t bills for it. If you did this would be up coding or fraud.
Good luck. I hope this helped cut through some of the red tape and answer some of the more common questions asked about billing insurance companies. Watch my site I will be writing more articles to help those starting out navigate the billing process.
Peter Spairring L.M.P.