In our continuing series on CPT codes, we will take a look at massage therapy and its close relationship with manual therapy in terms of procedure and billing code. These two therapies are often indistinguishable when viewed in practice, and each commonly experience billing errors when billed at similar times.
Learn more about these two therapies, their differences, goals, and billing nuance.
Massage Therapy vs Manual Therapy
Despite any visual similarity to the untrained observer, massage therapy and manual therapy each have their own procedures and treatment goals and are often accompanied by massage mediums, analgesics, and CBD oils and balms. The following looks at these two therapies, their codes—maintained by the American Medical Association (AMA) and the American Massage Therapy Association (AMTA)—and the differences between them.
Massage therapy, CPT code 97124, is a prescribed treatment typically performed without patient participation, or passive treatment.
Procedures under massage therapy include:
- Effleurage (circular movement),
- Petrissage (lifting and squeezing),
- Tapotement (stroking, percussion, and compression) as well as
- “Kneading, wringing, skin rolling, rhythmic percussion, cupping, hacking, or plucking.”1
There are many potential goals when prescribing massage therapy. Several common treatment goals include the following:
- Restoring muscle function
- Increasing circulation
- Decreasing specific stiffness
- Promoting tissue relaxation to the muscles
Treatments are generally applied to a large area over several types of soft tissue and regions.2
Manual therapy, CPT code 97140, is also a prescribed treatment that helps address loss of joint strength, mobility, and/or range of motion that is ultimately impeding function.
Procedures performed under manual therapy include:
- Manual traction,
- Myofascial release,
- Manual lymphatic drainage, and
- Trigger point therapy.
As manual therapy is often prescribed to help “treat restricted motion of soft tissues in the extremities, neck, and trunk,”3 treatment goals include the following:
- Restoring muscle or soft tissue function
- Increasing range of motion without pain
- Increasing myofascial tissue’s extensibility3
Treatments are generally applied to a specific area or region and can be both active and passive in patient participation.
Modifier “-59” & 8-Minute Rule
Due to the similar nature of massage therapy and manual therapy, proper billing and documentation require strict attention as there are nuances that must be considered. According to the National Correct Coding Initiative (NCCI), massage therapy (97124) and manual therapy (97140) are considered to be linked, meaning if one of these codes is billed, only one payment may be received despite two services being provided.4 In this instance, the modifier “-59” is often recommended.
Adding the “-59” Modifier
The “-59” modifier is applied to the end of the same code or a linked code for separate services performed in different 15-minute sessions. Because codes for massage therapy and manual therapy are linked, the appearance of these two codes billed at the same time for closely occurring services could be seen as double billing. The addition of the “-59” modifier signifies that a distinct treatment has occurred, allowing for two separate codes to be billed.
Complying with the 8-Minute Rule
It is important to remember that when billing for massage therapy and manual therapy, both must comply with the 8-Minute Rule. As discussed in the post “Codes 101: The 8-Minute Rule & Time-Based CPT Codes,” billing to Medicare and Medicaid requires meeting time minimums per treatment. For example, 1 unit of billable time is between 8 minutes and 22 minutes per service. Just as it is important to code correctly—detailing the procedures performed to highlight the differences in service—it is important to ensure services meet time minimums when billing to 8-Minute Rule compliant insurances.
Massage Therapy & Health Insurance Per State
As with all services, it is best to first verify if you are able to bill for massage therapy in your state as a precaution. To check your state’s requirements, please see this complete list here.
For more information about NCCI updates and edits, modifiers, additional codes, and more, please check out the American Physical Therapy Association’s (APTA) article, “National Correct Coding Initiative (NCCI).”
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1“Will Insurance Pay for Massage Therapy? Working with Insurance Companies.” Panda, 11 Dec. 2018, www.massageceu.com/insurance-and-massage/.
2“Coding Massage Therapy (97124) and Manual Therapy (97140).” KMC University, 2014, www.kmcuniversity.com/system/files/FS-Coding%20Massage%20Therapy%20(97124)%20and%20Manual%20Therapy%20(97140).pdf.
3Collins, Samuel. “Billing for Massage – Specific CPT Codes.” Dynamic Chiropractic – Chiropractic, News, Articles, Research & Information for Chiropractors – Find a Chiropractor, 4 July 2006, www.dynamicchiropractic.com/mpacms/dc/article.php?id=51260.
4Jannenga, Heidi. “CPT Codes & Physical Therapy: What You Need To Know.” WebPT, 22 Apr. 2019, www.webpt.com/cpt-codes/.
“Massage CEU State Requirements.” Panda, 2020, www.massageceu.com/states/.
“National Correct Coding Initiative (NCCI).” APTA, 5 Feb. 2020, www.apta.org/Payment/Medicare/CodingBilling/CCI/.