Neurology & Pain Management Coding Alert

Question: We get denials for 97124 for massage. Is it okay to bill some insurers for this using CPT 97140 , as it reimburses better and can also describe massage.

Michigan Subscriber

Answer: If massage therapy is a covered benefit, you should be able to bill using 97124 (massage, including effleurage, petrissage and/or tapotement). If the plan does not cover this, then you dont need to bill the insurer at all, and you would just collect the fee for massage directly from the patient. (Note: If it is a Medicare patient and you predict that the carrier will deny massage for the patients condition, you must ask the patient to sign an advance beneficiary notice ahead of time.) You absolutely do not want to disguise the noncovered massage as 97140 (manual therapy techniques, one or more regions, each 15 minutes), because you believe it may be reimbursable while the standard massage code is not. Any person who knowingly engages in a practice of upcoding for personal gain could face a $10,000 fine for violations of the Healthcare Accountability Act of 1997, an imprisonment of five years, or both.