Eli's Rehab Report

Question: I have been receiving denials from third-party payers when I bill 97110 (therapeutic procedure, one or more areas, each 15 minutes; massage). The reason for denial is that the service must be performed by a licensed massage therapist, but there is no licensing for massage therapists in my state. How can I get paid for this?

Michigan Subscriber

Answer: Several major insurance carriers have created nationwide mandates for their individual carriers to follow one such mandate is that massage will be reimbursed only when it is performed by a licensed massage therapist. According to the American Massage Therapy Association (AMTA), an organization that represents more than 37,000 massage therapists, only 29 states in the United States have state licensing boards for massage therapy, and Michigan is not one of them.

Dolly Wallace, a nationally certified massage therapist for 13 years who works at a chiropractic office in Muskegon, Mich., and serves on the AMTAs government relations committee helping states gain licensing for massage therapy, suggests using 97140 (manual therapy techniques) as an alternate code.

Wallace also says that a state license is valid only for practice in the issuing state, so using the services of a massage therapist with the out-of-state license probably will not change your reimbursement situation.
If a carrier tells a massage therapist that certification is required for reimbursement but the state offers no certification or licensing, the massage therapist may consider certification through the National Certification Board for Therapeutic Massage and Body Work.
You should contact your state medical board and request a letter stating that massage therapy is a legal part of your practice. Forwarding this letter to third-party payers may help to improve pay-up for massage therapy.

Answers to You Be the Coder and the Reader Questions were provided by Brenda Messick, CPC, senior consultant at Gates, Moore & Co., a physician practice management firm in Atlanta; Susan Callaway-Stradley, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C.; Patricia Niccoli, HBMA, president of ElectroAge Billing, a medical billing firm in Phoenix; and Robert Mortensen, RCP, CRTT, University of Washington, Harborview Medical Center, Seattle.