Thinking About Insurance Reimbursement? Know the Facts / Weigh the Benefits & Risks
Q& A With Susan Rosen, AMTA’s CPT Representative
With the recent health care debates taking place in Washington, D.C., and across the nation, AMTA has seen an increase in the number of questions dealing with health care insurance reimbursement. While the issue remains complex and is continually evolving, AMTA recently spoke with Susan Rosen, AMTA’s representative to the American Medical Association’s (AMA’s) Current Procedural Terminology (CPT) Health Care Professional’s Advisory Committee, to put together some of the basic facts about insurance reimbursement.
What are some of the most important things massage therapists should know before considering insurance reimbursement?
Health care is a moving landscape, and it’s easy to get intimidated. In order to continue to advance our profession, we, as massage therapists, need to be willing to be part of the larger health care conversation.
In Washington state, where I practice, massage therapists are recognized as health care providers, but we still have a choice as to whether or not we bill insurance companies for our services. And just like every state handles the licensing of massage therapists differently, each insurance company handles billing and reimbursement differently. Massage therapists should first educate themselves about insurance reimbursement before determining if it can be beneficial to their practice.
How do individual states’ massage therapy practice laws influence whether a massage therapist can bill for insurance reimbursement?
A state’s massage therapy board (or other governing board) determines whether a specific procedure or service is within a massage therapist’s scope of practice. Even though a state allows a massage therapist to perform a specific procedure or service, it does not guarantee that the therapist will be reimbursed for the service. This is determined by the client’s insurance coverage, and if the specific insurance company reimburses massage therapists for their services.
Contact information for each state that has a massage practice board can be found on AMTA’s Massage Information Center at www.amtamassage.org/government/state_laws.html
How do massage therapists find out if their clients have coverage for massage therapy services?
Ideally, massage therapists should have their clients contact their health insurance companies before an appointment and ask if a massage therapy benefit is included in their coverage. The client should also confirm that the therapy can be performed by a massage therapist.
Some insurance companies may have massage therapy included in plans as a “wellness benefit.” If this is the case, the insurance company might then contract with a massage therapist at a reduced rate and also refer clients to the massage therapist. These clients pay out of pocket but at a reduced rate.
What are CPT codes and who develops them?
CPT stands for Current Procedural Terminology. The codes describe specific procedures and services performed by physicians and health care providers. They represent the standard terminology used to bill for insurance reimbursement. The AMA forms committees to develop and review the CPT codes. As AMTA’s CPT representative, I participate in and discuss issues related to CPT codes that impact massage therapists
What are the specific CPT codes that massage therapists can use?
These are some of the CPT codes commonly used by massage therapists; some are used more commonly than others.
• CPT Code 97124
• CPT Code 97140
• CPT Code 97112
• CPT Codes 97010
• CPT Codes 97110
For further clarification on these CPT codes, please refer to American Medical Association. CPT, Professional Edition, 2010, under the heading of Physical Medicine and Rehabilitation, Modalities and Therapeutic Procedures.
Before billing the insurance company, massage therapists should first confirm they are eligible providers and also confirm which codes the company reimburses. Usually a prescription from a referring doctor is required to verify medical necessity.
Massage therapy services are also covered under personal injury protection (PIP) through auto insurance, which is separate from health insurance coverage.
Where can a therapist find forms for insurance billing? Are there companies that will handle insurance billing?
Insurance reimbursement forms can be found through health insurance websites. For electronic billing refer to OneHealthPort.com. Alternatively, there are companies that will complete and submit all required insurance billing paperwork.