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Medical Massage with Insurance

Is anyone having any luck getting reimbursed for 97140 or 97124 performed by a massage therapist with any state plans? I have completed all of the required steps to become a provider in South Carolina, but when I checked with BC/BS to verify benefits, they said it only covers chiropractors and physical therapists. This doesn't make sense as we are the ones that specialize in it. I have referrals from specialists to provide therapy to patients who are not good candidates for surgery due to the risk outweighing the benefits. Sometimes it takes 2-3 hour session to achieve results at a time. Chiropractors and Physical Therapists don't spend that kind of time doing manual therapy.

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Permalink Reply by Daniel Cohen on April 18, 2012 at 10:14am

Makes no sense at all. When I have applied to be a provider the insurance company just sends the papers back asking for the same papers they are returning. They simply don't want to pay.

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Permalink Reply by Keebra S. on April 18, 2012 at 11:03am

Hi,

Hope all is well. From previous work experience, working with insurance so hectic and time consuming. Have tried pre-authorization or verify prior submitting insurances from clients. Hopefully this is helpful.

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Permalink Reply by dennis marion nelson on April 18, 2012 at 12:17pm

I have heard how frustrating it is dealing with insurance companies. This may be why a lot of LMT's don't want to pursue it. That is why I had my son do all the leg work because he is a certified coder. Got all that done, it is just that my taxonomy code is not what they will reimburse for- only chiropractors and physical therapists in South Carolina. Getting the provider status is possible- just time consuming. It is best to deal with the provider's credentialing department by email with a discussion. That is what we did. Somehow we have to get people to put into their policy to get 97140, 97124, and 97112 to be performed by an LMT. My wife says it is up to the employer what is put into the policy, not the insurance company. I would like for our ABMP to help educate people on this. Does anyone know of an organization dedicated to educating the public on medical massage and how to understand their insurance policies?

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Permalink Reply by Gordon J. Wallis on April 18, 2012 at 1:23pm

I delt and made a living billing insurance companies for about ten years... I made a good living....However it was a constant pain in the butt. I had to call, scream, beg, and demand my money on a never ending basis...Its cash only now. Much better for me.

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Permalink Reply by Pete L Blanco II on April 19, 2012 at 5:59pm

This is why I don't bill to any health insurance plans. Most of them don't/won't pay to a massage therapist though they will pay to a DC or PT, even though the DC or PT is having the massage performed by an MT in their office. The difference by their reasoning is that the MT working in the DC or PT office is "working under the supervision" of the DC or PT whereas those of us in our own practices are not. Doesn't make much sense to me either...

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Permalink Reply by Pete L Blanco II on April 25, 2012 at 5:19pm

Dennis wrote: "Sometimes it takes 2-3 hour session to achieve results at a time."

I missed this the first time I read your post. If you are billing for a two-to-three-hours-long session, that might be one reason you're having difficulty getting reimbursed by insurance. (Beyond the DC/PT vs MT issue.) Quite generally speaking, insurance companies will only reimburse for a maximum of 4 units (1 unit = 15 mins) per session and depending on the client's specific diagnosis, shorter sessions may be indicated. In other words, just because insurance typically maxes out at 1 hour of treatment, doesn't mean they will always cover a full hour of treatment per session. It's all based on medical necessity.

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Permalink Reply by dennis marion nelson on April 26, 2012 at 9:57am

I would be happy if they recognized my taxonomy code- even if it were only 1 unit. My wife, who deals with insurance, says it has to be in their policy. One question is, how do we get people to place that into a state plan (been there and done that with the representatives in government. Brick wall!). Only reason I mentioned the 2-3 hours is because of the results achieved- given that the clients/patients are 'inoperable' according to their surgeon. So, from a fiscal point of view, our services save insurance premiums/dollars as well as taxpayer dollars. In a time when SSI disability is scheduled to be insolvent by 2016 and health care is being attempted for overhaul at a federal level, should we not be getting a platform to say we, as medical massage practitioners, have something to offer?