Will Insurance Pay for Massage Therapy? Working with Insurance Companies

Insurance and Massage: Can Insurance Pay for Massage Therapy?

When someone’s suffering from chronic pain, acute injury, or high levels of stress and anxiety, massage can be a powerful tool to aid in recovery and general wellness. As a massage therapist, you’re already well aware of this. You see patients come in with a wide variety of issues — everything from a back spasm to trauma-related injuries — and help them get back on their feet (sometimes literally) with the power of massage.

As a practitioner of massage, you’re always looking to offer your services to as many clients as possible. But, the act of broadening your ability to help a larger range of clients can take different forms. On the one hand, you can focus massage therapy continuing education courses. By learning about specific techniques like sports massage and deep tissue massage, you’ll be able to provide a greater variety of services to your clients — which can translate to more clients served at the end of the day. As an aside: when working on continuing education, it’s important to ensure that your massage CEUs come from an NCBTMB approved provider in order to ensure their acceptance by your state’s massage therapy licensing board.

This is one way to think of widening the scope of your practice. But, there’s another approach you can take if you want to see more clients. Rather than requiring all of your clients to pay for services rendered out of pocket, you might consider offering clients the option of billing their health insurance provider for reimbursement of the cost of their visit.

Believe it or not, it is indeed possible to bill health insurance companies for a massage session in many states around the country. If you’re a little hesitant to dive in head first, though, that caution is probably warranted. Talk to any medical office’s insurance billing staff (that’s right: most health care providers have a dedicated team that handles this, assuming they don’t completely outsource the responsibility to an external company) and they’ll tell you just how complicated it can actually be. There are diagnostic codes, billing codes, forms, record keeping, paperwork, and all sorts of other things to consider.

That said, billing insurance for massage is possible in some parts of the country — and it may make a lot of sense for your practice. That’s why we’ve put together this guide to answer some common questions related to billing insurance as part of your massage practice.

In this blog post, we’ll cover:

• What to consider when deciding whether or not to bill insurance for your massage services
• Rules and regulations in specific states
• CPT codes and how they work
• The difference between ICD-9 and ICD-10 codes, and why they matter
• Sample ICD-10 codes that may apply for massage therapists
• How to handle paperwork related to billing insurance, along with outsourcing options
• Massage therapy continuing education as part of your professional development

Ready to find out more about when insurance will pay for massage therapy? Let’s jump in and get started.

Billing Insurance for Massage Therapy: Things to Consider

As you’ve probably already gathered from what was said above: billing a health insurance company for massage therapy is no simple task. It’s not something you can simply decide to do and then immediately implement into your massage practice. Doing so will require a significant amount of preparation, along with a major amount of follow-through in order to actually execute on the back end.

For that reason, it’s important to take a moment to consider why you want to participate in insurance company billing in the first place.

Are you simply looking to bring in more revenue from your clients? Some massage therapists want to bill insurance because they believe it would increase their level of income by simultaneously bringing in more patients (who wouldn’t otherwise seek out massage due to affordability issues). In some practice areas, this may be sensible. Particularly if you choose to specialize in something like treatment for post-accident injuries and other acute issues, being able to bill insurance can make a lot of sense.

There’s no question that the thought of being able to treat more patients and increase your revenue sounds like a positive thing. On the flip side, though, there are a number of potential drawbacks that need to be taken into account.

First off, it’s important to understand that a primary care doctor will generally need to write a prescription for massage in order for a client to actually receive reimbursement from their insurance company. In the vast majority of cases, a client can’t simply come in for a massage of their own accord and later seek reimbursement from an insurance company. Instead, they’ll usually need both a prescription as well as a pre-authorization to treat from their insurance company. Taking the time to explain this to patients — and providing them with the necessary guidance as they navigate these often-complicated steps — can create a massive amount of extra work for your massage practice.

When you take into consideration the paperwork that’s required on top of this, you may find that the supposed increase in revenue as the result of increased client traffic is more or less counterbalanced — or even outweighed — by the added stress, aggravation, and paperwork. Only you can determine this for your own practice based on the particularities of your situation. For example, a massage therapist working as part of a larger integrative health practice may be able to hand over certain paperwork responsibilities to the office’s billing and claims department. In these sorts of situations, billing insurance can indeed be an excellent idea.

Can I Bill Insurance for Massage in My State?

If you do decide that billing for insurance reimbursement is a good idea in your particular situation, there’s still more to think about. As we’ve already mentioned, every state is different when it comes to massage therapy and health insurance (click here for a complete list).

One of the biggest determining factors in many states has to do with your classification as a massage practitioner. In some states, massage therapists are classified as health care practitioners, or HCPs. Washington state is an example of one such state with very clear guidelines for what a massage therapist must do in order to both obtain licensure and be considered an HCP.

If your state doesn’t classify massage therapists as health care practitioners, you may be unable to bill insurance for the services you provide to your clients. Check with your individual state’s licensing board, as they’ll be able to provide you with more detailed information.

CPT Codes and Massage Therapy

Assuming you’ve decided to incorporate insurance billing in your massage practice and have determined that you’re eligible to do so in your state, the next step in the process is understanding more about the billing paperwork and particularities involves.

One aspect of the associated paperwork that you’ll need to familiarize yourself with is something called a CPT code, or Current Procedural Terminology code. In layman’s terms, CPT codes serve as a national standard for codifying individual medical procedures. The coding system is maintained by the American Medical Association (AMA), and the American Massage Therapy Association (AMTA) was brought onboard to offer input into the development of specific language related to treatment modalities associated with massage therapy.

While there are many, many CPT codes out there, most massage therapists will only make use of a handful as part of their billing paperwork procedures. Here are a few examples of billing codes that you might use as part of your massage practice:

• CPT Code 97124 Massage Therapy
• CPT Codes 97110 Therapeutic Exercise
• CPT Code 97112 Neuromuscular Re-education
• CPT Codes 97010 Hot/Cold Packs
• CPT Code 97140 Manual Therapy

ICD-9 vs. ICD-10 Codes and Insurance Billing Paperwork

If you’ve done a bit of reading about health insurance billing, you’ve probably come across something called ICD-9 and ICD-10 codes. Now that you understand what CPT codes are, you’re probably wondering: what exactly are ICD-9 and ICD-10 codes, then? How do they fit into the picture?

ICD stands for International Classification of Diseases and refers to an exhaustive list of health conditions developed by the World Health Organization (WHO). The ICD codes are intended to serve as an international standard for the identification, classification, and subsequent treatment of disease. Keep in mind, though: it is not your responsibility as a massage professional to diagnose a client’s medical condition. This will always be done ahead of time by a primary care physician.

Up until 2015, ICD-9 codes were in use throughout the world in order to classify diseases. Beginning 2015, health care professionals began to make the switch from ICD-9 to the newly implemented ICD-10 codes. While there are a number of differences between the two coding systems, one of the most significant points of departure between them is how much more specific ICD-10 codes are than ICD-9 codes. For example, as you’ll see below, ICD-10 codes require specifying not just that a client has pain in their shoulder, but which shoulder the pain is in.

Examples of ICD-10 Codes for Massage

As we’ve already pointed out, it’s absolutely not up to you as a massage therapist to determine the diagnostic code for a client. As an allied health professional, you won’t be in a position where you’re serving as a client’s primary health care provider. Therefore, you’ll never be expected to diagnose a client’s health issue the way that a primary care doctor would. This is not part of your scope of practice and attempting to do so could land you in trouble with massage licensing officials in your state (not to mention other authorities).

That said, there are a wide range of ICD-10 codes which a physician may use when diagnosing one of their patients and subsequently writing a prescription for massage therapy as part of their treatment plan. Having some familiarity with these codes ahead of time will be helpful. If a client comes to you with an ICD-10 code and accompanying diagnosis that you’ve never seen — and which appears to be completely outside your scope of practice as a massage therapist — you’ll want to contact that client’s primary care provider for clarification.

With this in mind, here’s a list of some common ICD-10 codes that you might run into if you opt to allow clients to seek reimbursement for your massage services. Keep in mind that this list isn’t intended to be exhaustive: this is simply a starting point, and it’s merely meant to give you a general idea of the types of diagnostic codes that you’re likely to see.

Pain-Related ICD-10 Codes

• 529 Pain in unspecified elbow
• 521 Pain in right elbow
• 522 Pain in the left elbow
• 539 Pain in unspecified wrist
• 531 Pain in right wrist
• 532 Pain in left wrist
• 519 Pain in unspecified shoulder
• 511 Pain in right shoulder
• 512 Pain in left shoulder
• 643 Pain in unspecified hand
• 641 Pain in right hand
• 642 Pain in left hand
• 559 Pain in unspecified hip
• 551 Pain in right hip
• 552 Pain in left hip
• 569 Pain in unspecified knee
• 561 Pain in right knee
• 562 Pain in left knee
• 579 Pain in unspecified ankle and joints of
  unspecified foot
• 571 Pain in joints of right ankle and right foot
• 572 Pain in joints of left ankle and left foot

Codes Specific to Back Pain

• 30 Sciatica, unspecified side
• 31 Sciatica, right side
• 32 Sciatica, left side
• 2 Cervicalgia
• 6 Pain in thoracic spine
• 5 Low back pain
• 89 Other dorsalgia
• 81 Other neuralgia
• 9 Dorsalgia, unspecified
• 27 Fusion of spine, lumbosacral region
• 28 Fusion of spine, sacral and sacrococcygeal region
• 2X7 Spinal instabilities, lumbosacral region
• 3 Sacrococcygeal disorders, not elsewhere classified

Edema and Lymph Node Issues (Lymphatic Massage)

• 0 Localized edema
• 1 Generalized edema
• 9 Edema, unspecified
• 9 Enlarged lymph nodes, unspecified
• 0 Localized lymph node
• 1 Generalized lymph node

Taking Health Insurance: Handling Paperwork

The paperwork component of billing insurance for massage is potentially the most daunting of all. You may be surprised to learn that health insurance claims are actually legal documents, which means that accurate and extensive record keeping is paramount.

Some of the things you’ll need to keep track of in order to file for insurance are:

• Photocopies of your clients’ insurance cards
• The client’s primary care provider’s prescription or referral document
• Documented pre-approval request from the insurance company
• SOAP (Subject, Objective, Assessment, Plan) notes
• Documents demonstrating HIPAA compliance
• Client’s authorization to release medical information
• Signed statement that the client will pay for any services not covered by insurance

This list is far from exhaustive. Considering the amount of paperwork involved, many massage practitioners who bill insurance opt to outsource the process entirely to athird-party company. Keep in mind, though: this will increase your costs considerably.

Massage Therapy Continuing Education

If you’ve decided to attempt to bill for health insurance as part of your massage practice, this guide should have provided you with a solid overview of what you’ll need to know and where to start. Again, we highly recommend contacting your state massage licensing board for more information.

Remember, though: growing your practice isn’t limited to taking insurance in order to bring in new clients. Massage therapy continuing education courses from Panda™ can give you the skills you need to offer new and exciting services to a wider range of clients. As an NCBTMB approved provider of massage CEU courses, Panda offers the best value available anywhere when it comes to online massage CEUs. Click here to check out our affordable prices and sign up today.