Julie Onofrio

ICD -10 codes for Massage Therapists

May 25, 2019 by Julie Onofrio 11 Comments

Yes ICD -10 codes are here and there is a lot of information that you will need to know. International Statistical Classification of Diseases and Related Health Problems codes are created by the World Health Organization and are used around the world. They are diagnosis codes that are used when doctors prescribe massage so you will need to be up on what is going on.

The next version – ICD-11 are already on the way. In May 2019, ICD-11 will be presented at the Seventy-second World Health Assembly for endorsement by Member States. In January 2022, Following endorsement, Member States will begin reporting health data using ICD-11. (WHO timeline)

ICD-9-CM codes were 5 digits

First digit is alpha (E or V) or numeric
Digits 2-5 are numeric
Decimal is placed after the third character
14,000 codes

ICD-10-CM codes are 7 digits and there are 69,000 codes to better capture specificity.

Digit 1 is alpha.The two main category of codes massage therapists will see most of are the M and S codes:
- M = musculoskeletal or connective tissue condition
- S = injury or consequences of external causes
Digit 2 is numeric
M00-M25 Arthropathies
(M00-M03) Infectious arthropathies
- (M05-M14) Inflammatory polyarthropathies
- (M15-M19) Arthrosis
- (M20-M25) Other joint disorders
- M40-M54 Dorsopathies
- (M50-M54) Other dorsopathies(M45-M49) Spondylopathies(M40-M43) Deforming dorsopathies
- M60-M79 Soft tissue disorders
- (M60-M63) Disorders of muscles
- (M65-M68) Disorders of synovium and tendon
- (M70-M79) Other soft tissue disorders
- M80-M90 Osteopathies
- M91-M94 Chondropathies
- M95-M99 Other disorders of the musculoskeletal system and connective tissue
- S00-T14 – Injury
  - (S00-S09) head
  - (S10-S19) neck
  - (S20-S29) thorax
  - (S30-S39) abdomen, lower back, lumbar spine and pelvis
  - (S40-S49) shoulder and upper arm
  - (S50-S59) elbow and forearm
  - (S60-S69) wrist and hand
  - (S70-S79) hip and thigh
  - (S80-S89) knee and lower leg
  - (S90-S99) ankle and foot
  - (T00-T07) involving multiple body regions
  - (T08-T14) unspecified parts of trunk, limb or body region
Digits 3–6 are alpha or numeric
For “M” and “S” category codes, the side of the body is indicated. Generally:
1 = right
2 = left
Note: There are a variety of different methods for denoting bilateral locations
Decimal is placed after the third character
7th digit is a special extension code that will be alphabetical and is required for injury codes that start with S.

A: Initial Encounter – Patient is receiving active care. You can use A on multiple claims for the same condition – it really isn’t just for the first encounter. “A” code for initial encounter is used for all sessions related to the “active” treatment for the symptoms called out in the ICD10 code.
D: Subsequent Encounter – After patient has received active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase. Rehab therapy is usually considered to be part of the healing and recovery phase. The “D” code is used for subsequent treatments to check on the patient/client after active treatment is completed.

S: Sequelae — Complications or conditions that arise as a direct result of the condition that are caused from the direct result of an injury or condition.
Fractures have a different extension code than other conditions based on open vs. closed, routine vs delayed healing, non-union or malunion.

ICD-10 codes will provide specific locations for injuries. They will also document chronic or acute pain issues. The new codes are much more specific and will provide us with much more information about diseases and their treatments which will help with health management and research.

Since these are diagnosis codes and massage therapists can not diagnose clients, the codes will come from the doctor. The doctor may or may not write the actual description of what the code means so you may have to look the code up to know what it means. It is best to get the actual code from the doctors so that you can put the same code on the bill as the doctor does to tell the insurance that you are working on the same condition. Often times there are a variety of codes that can be used for one condition so it is important to know which one the doctor is using. There are many free code look up databases online. See ICD 10 Look up from CMS.

Here also are some common orthopedic codes that are used for rehabilitation

M54.2 Cervicalgia
M50.01 Cervical disc disorder with myelopathy, occipito-atlanto-axial region
M50.02 Cervical disc disorder with myelopathy, mid-cervical region
M50.03 Cervical disc disorder with myelopathy, cervicothoracic region
M54.30* Sciatica, unspecified side
M54.31 Sciatica, right side
M54.32 Sciatica, left side
M54.40* Lumbago with sciatica, unspecified side
M54.41 Lumbago with sciatica, right side
M54.42 Lumbago with sciatica, left side

There are specific codes just for pain. It has been previously said that massage therapists can use pain codes to bill the insurance without a prescription. I have never seen a health care plan that does not required massage to be medically necessary which means a prescription is needed. Pain needs to be carefully diagnosed to rule out more severe injuries or conditions like heart attacks, kidney stones etc. Here are common pain codes:

Shoulder — M25.511 (R), M25.512 (L)
Upper Arm — M79.621 (R), M79.622 (L)
Elbow — M25.521 (R), M25.522 (L)
Forearm — M79.631 (R), M79.632 (L)
Wrist — M25.531 (R), M25.532 (L)
Hand — M79.641 (R), M79.642 (L) (excludes fingers)
Hip — M25.551 (R), M25.552 (L)
Thigh — M79.651 (R), M79.652 (L)
Knee — M25.561 (R), M25.562 (L)
Lower Leg — M79.661 (R), M79.662 (L)
Ankle — M25.571 (R), M25.572 (L) (excludes foot/toes)
Foot — M79.671 (R), M79.672 (L) (excludes toes)
Thoracic Spine — M54.6
Low Back Pain — M54.5

As you can see, these codes are much more specific so that will give you so much more information and tracking the codes will provide data for various conditions to see what therapies work best.

There is much more to billing insurance then just putting an ICD-10 code on a bill. Learn to bill insurance and see my plan to get massage therapy covered by health insurance in every state in my book : Massage Insurance Billing.

Other resources:

CMS Provider resources

World Health Organization

Originally written Aug 6th 2015. Updated Jan 30 2016, Updated 05/25/2019

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Google Business Listing for Your Massage Business

May 24, 2019 by Julie Onofrio Leave a Comment

Google Business Listings is a business profile on Google that also gets you on Google Maps as well as search. With more people searching on maps these days, this can be very helpful in getting and keeping clients.

The thing about people finding you on Google is that people are searching for massage there which means they are looking for someone to give them massage. This is ideal to start with. You aren’t randomly looking for clients like you are when you are on a social media site.

Head over to Google Business.

Sign up or sign in. Check to see if your business is listed on Google.com/maps first. If it is, you can claim the business. If you already have claimed your business, you can login to Google Business. and make sure your profile is accurate and keep it up to date.

You can also maximize Google Business by adding photos of your office and store front and posting to your listing daily.

Join my Facebook Group to get help with your Google Business Listing and building your massage business.

Educating Massage Clients

May 18, 2019 by Julie Onofrio Leave a Comment

Educating Massage Clients is one of the best ways to create awareness and acceptance about massage. Education is not talking at people telling them about massage, about what you can do and why they should get a massage. The root word of Education is the Latin word educare, which means to “draw out.” To educate, therefore, means to draw out something that fundamentally is already there. In the process of education, you actually become aware of yourself. In most of our standard examples of education like in public schools and in massage school it becomes just a memorizing of information and a regurgitation of that information. It isn’t education.

To educate clients and potential clients it is more about building a relationship with them. It is about setting aside your own agendas to even get a massage appointment and showing a real interest in them. It begins with asking people questions to find out their needs. Then if you find that their needs match what you have to offer you can then easily talk about what massage can do for them.

I have heard a few massage therapists say things like ” I have sent many letters over the years to doctors and others trying to educate them and it didn’t work.” While I don’t know for sure what was in the letters I would guess that it wasn’t educating and it was more about them. It might have been more along the lines of presenting information that the recipient wasn’t interested in.

To educate others you need to forget what you know about massage – all the big terms, the name of the muscles and things like that. The ‘Curse of Knowledge” from Chip and Dan Heaths Book “Made to Stick” says:

Once we know something it is hard to imagine what it is like to not know it. Our knowledge has cursed us. And it becomes difficult for us to share our knowledge with others, because we can’t really create our listeners state of mind.

Make sure your website and communication is about the client and what is in it for them. So often massage therapists make the mistake of making everything about themselves. Assume that people know little to nothing about massage and what it can do until you find out otherwise. Keep it simple and in plain English.
You need to understand what your client/potential client wants. They start with saying they want to feel better or be out of pain – but why? So they can play a sport better? So they can play more with their kids? So they can enjoy their work, home life, vacation? Ask questions to get to their why? Tell them how you will help them solve their problems and help them achieve their goals.
People want to know that you are the expert and can handle whatever health issue that they have and that you will be able to do the right thing to help them. Let them know that you understand by sharing a story about other client situations (without names or client ID) or let them know a story about you. You are the EXPERT! People want to know that. Google wants to know that too! Google wants your website to be good enough to pass their E-A-T guidelines that were just released by Google in 2014 and recently updated

E-A-T (“Expertise, Authoritativeness or Trustworthiness”
Believe in what you do. Understand what you do. Be always learning about what you do. But more than that, make sure you know how to express that belief without sounding like a used car salesman.

Example: I started my business renting a room out of a health club in downtown Seattle. I used to sit at the front desk and greet club members and hand out towels and locker keys. One guy would go out running when he was there and he did his stretching by the front desk and would stop to talk. He kept saying “Oh I need to get a massage someday” etc etc but never would book. One day I asked him why he was running so much – did he have a personal goal or was he training for some event. Turns out he was training for a marathon. When I was able to make the connections to how massage could help him run better and train better, he signed up for a massage….not just one massage… but one massage a week for about 10 years.

Yesterday on Facebook I saw this post from the Real Housewives of Beverly Hills show that showed just how much people do not know about what massage is and who massage therapists are. We have lots of work to do.

Educating massage clients and potential massage clients

Originally written on June 5 2010. Updated May 18, 2019

Explaining Your Prices

April 27, 2019 by Julie Onofrio Leave a Comment

As a massage therapist, there will always be people asking for a discount. We have become a discount economy. They may have found someone else charging half of what you are charging or they just want a discount. If people are asking you this just remember that you NEVER have to explain why you charge what you charge. Don’t take it personally when they ask.

People are used to getting discounts . Just because they ask you doesn’t mean they are bad people or are destined to be bad clients. It also doesn’t mean they’re challenging your value personally. You know you are taking it personally when you respond with something like the quote:

My Prices are based on my talents,
not your budget.

The problem is that this was actually found on a sign and other massage therapists were using it to promote themselves. This just is unprofessional. Claiming that your talents are worth more than anyone else’s is really not true. Telling clients that their budget may not be able to afford you is really shaming them for not having enough money or not budgeting enough for massage. You just don’t know why they were asking for a discount. Be curious and find out!

This isn’t the way to make a good impression. Your prices are not based only on your talents. Your prices should reflect your skills, trainings and time. They reflect how much you pay for rent and advertising. They are not really about YOUR value or how much you are worth. How much is a massage worth anyways? How much is it worth to be out of pain and have the weight of the world on your shoulders relieved? $70? $100? $1000?

The best way to handle this is to make sure your work speaks for itself and that also means your website, social media and other places where people find you.

The Best Way to Handle A request to reduce your prices.

Depending on the situation and if there is time to respond – start with asking the person why they are seeking a massage. Do they have something that they want to achieve or some goal they are working towards? Are they in pain or stress and need some relief from that?

When people are talking about money and prices, they are usually referring to something else. It isn’t really about the price point. They don’t yet trust you. They don’t know you. They don’t understand your value. They may have gotten a few lousy massages and paid too much for them at a high end spa or something like that. They do not know how you are different than all of the other massage therapists out there. These same people will shop at Nordstrom rather than Walmart, stay at 5 star hotels and drive a Mercedes or Lexus. It usually is NOT about the price. Find out what it is really about by asking questions about them.

What are you getting massage for – some kind of pain/stress issue?
What is that issue preventing you from doing – walking the dog, playing with kids/grandkids, sleeping, sitting at work, focusing….
What things have you tried to help with that?
Did massage help before?
What did you like about your last massage (or not like)?

Get them talking. You will usually get to the reason why they want a discount. Then you can get to telling them why your massage is different and why they should try you. Focus on the outcomes of what you have seen. Focus on your expertise in the area without being egotistical about it.

You can’t do that with everyone of course. Some people will be more difficult. In that case you can just say something that won’t be offensive, but may get them talking in other ways.

Oh that is interesting. I wonder how they make that work?
Ask what do you get for that amount?
Tell them that 30 minute sessions are available to try you out first before committing to an hour or 90 minute session.

Make extra income through creating a website

December 15, 2018 by Julie Onofrio Leave a Comment

One of the things I have in place to supplement my income as a massage therapy is creating websites related to massage therapy – like this one. My first site was www.thebodyworker.com (Now defunct) that I used to just put my notes from massage school online. The way it came about was that I a was having health challenges that kept me from working. At the time it was just a hobby to keep me busy when I felt bad. I started it in 1999 or so and didn’t know anything about creating sites. From there I somehow found an ebook called Make Your Site Sell, by Ken Evoy and learned more and more about the possibilities of creating income from a website. Today that ebook has worked itself into a whole online business creating system and website builder – SBI! (Solo Build it! previously Site Build it!).

I used SBI! to create my second big successful website – www.massagetherapycareers.com (which I sold in 2008 for enough to live on for one year
and the owners crashed it into the ground! The completely changed the content and made it into a sales site for massage schools. Smiling all the way to the bank 🙂

What would you do a site on?

What are your hobbies, interests, passions? What do you know alot about? What are you an expert at or what are you an expert at doing?

Massage, some aspect of health, knitting, soccer, stock trading, gardening, dog training, destinations, your local community….. you name it. It can be made into a profitable topic…somehow….someway.

The way it is done is to take these hobbies, passions, interests and expertise and start with brainstorming your topic through a comprehensive process of keyword research. (Using proprietary software included with SBI.) The software gives you an idea of how many searches there are for that word compared to how many sites there are that provide that information. It also takes into consideration possible ways to make money.

Don’t think you have anything worth writing about?

Think again. Don’t let your old fears get in your way.

Every time I see things in happening around me, I can think of a website that would help and that I would love to do. Some of my massage related ideas are:

A website on each type of pain condition that I see like hip pain, neck and back pain…etc
A general website on Pain and the science of pain
A website on all of the research on massage therapy that takes each study step by step and analyzes it and then explains how massage therapist can use this information.
How to start and run a massage school
How to teach couples massage classes to the public to make money doing that and to build your massage business too.
How to start and run a mobile massage business.
How to start and run a franchise
How to start and run a massage therapy co-op.
A directory of local massage therapists (use WordPress plus the SBI plugin for WordPress)
A directory of local CE classes. (use WordPress plus the SBI plugin for WordPress)
A travel site on high end spas. use WordPress plus the SBI plugin for WordPress)
A site on books on massage for therapists
A site on all of the various online scheduling apps/systems and reviews of them all.
Your massage school notes. (Buy my site – www.massageschoolnotes.com to get a good start)
A site that talks about the issues of being a male massage therapist.
A website that deals with the issues of sexual assault, illegal massage businesses and human trafficking issues and that promotes massage therapy.
A website on REAL massage. (https://amta-wa.org/page/REAL_overview) REAL massage is :
- Responsible – REAL massage therapists recognize the honor of responsibility that comes with providing people with massage.
- Ethical – REAL massage therapists are bound by best practices conveying ethical business sense.
- Accountable – REAL massage therapists thrive in accountability to, and encouragement of, one another as we help each other grow our businesses to reach their potentials.
- Licensed – REAL massage therapists in WA states are licensed through the Department of Health, being recognized as healthcare practitioners.
A website on hospital based massage – how to start and run a program in a hospital. Look into reviving the Hospital Based Massage therapy network. (http://hbmn.com)

Non-massage related ideas:

I feel really concerned about the plastic thing… the pictures of plastic in the oceans and all over and how we got this way and what we can do about it. I don’t know anything about it but it is worrisome and would take some reading and research.
I love reading books and keep thinking I should do a site on some aspect of reading – – not sure what aspect…but I am sure I could find it.
A website on feral cats living in barns.
A local directory for your city/town/county for locals or for tourists. (use WordPress plus the SBI plugin for WordPress)
A travel site on your favorite beaches or ski resorts. (use WordPress plus the SBI plugin for WordPress)
A website on hiking the Pacific Crest Trail or Appalachian Trail

I can hear your objections already…. aren’t there enough websites on those topics? There are never enough GOOD ones let alone GREAT ones. Just look at the sites out there. Most are getting so spammy with ads popping up all over and having stories that you have to click 100 times to see all the images just to get to the one important thing…. We need better websites that inform and educate.

Take a look at these case studies and this list of results and list of websites using SBI for proof.

How do you make money with a website?

In the early days, I made the most of my income from Google Adsense. Putting Google ads on my site. How much? Well it got up to about $2000 a month before 2009 when Google made big changes in their search algorithms. Since then I have started writing ebooks and am not getting back to working on a few sites that will have more Adsense ads and affiliate income mainly through Amazon associates program.

You don’t know anything about creating websites?

You don’t have to. SBI! provides EVERYTHING you need to know about how to use their proprietary software and if you want to use WordPress, they will help you will all that too with a complete action guide for each type of software. (WordPress just released their 5.0 that includes a block by block builder which will have a big learning curve.)

EVERYTHING? Yes Everything.

How to choose a topic
How to choose the best domain
How to set up your home page
How to create pages so that search engines will find them
How to use Social media – Facebook, Twitter, Pinterest, Instagram to build traffic
How to write (anyone can learn!)
How to make money
How to create products
How to sell other people’s products (Affiliate Income)

How long will it take?

It’s a process. It takes as long as it takes. It won’t happen overnight and it isn’t a get rich quick thing.

It is building an online business – one that could supplement your massage income and make you money while you do massage and take you into retirement. (I have so many plans for other websites that I can play with in ‘retirement’, I can hardly wait!)

Medicare Advantage Plans to cover massage therapy

December 11, 2018 by Julie Onofrio 2 Comments

Step by step…little by little…. massage therapy is being accepted by health insurance.

The latest step is the news that 270 Medicare Advantage Plans WILL be covering massage therapy. It was a part of recent efforts by AMTA to make this happen.

AMTA News Brief September 4, 2018: AMTA Reaching Out to 700 Medicare Advantage Plans

The Centers for Medicare & Medicaid Services (CMS), the federal government department that administers the Medicare program, recently issued guidelines that named massage therapy as a medically-approved, non-opioid treatment alternative.

AMTA News November 28, 2018: CMS Announces Up to 270 Medicare Advantage Plans Will Include Massage Therapy in 2019

The CMS Press release says:

Medicare Advantage enrollment is projected to increase to an all-time high from the current enrollment of 20.2 million to 22.6 million in 2019, an 11.5 percent increase compared to 2018.

As a result of the new flexibilities on supplemental benefits available for the first time in 2019, about 270 plans are providing nearly 1.5 million enrollees with access to the following new types of benefits:

Expanded health related supplemental benefits, such as adult day care services, in-home support services, caregiver support services, home-based palliative care and therapeutic massage; and

Medical advantage plans are HMO or PPO plans that are approved by Medicare. There are many different types of Plans so it is not clear where the massage therapy benefits will come into play. People purchase these plans above and beyond their Medicare coverage.

Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare. Medicare pays these companies to cover your Medicare benefits.

What does that mean?

We don’t really know yet and don’t have enough information.

That specific language is concerning to me… do they mean that massage therapy will only be used in home based palliative care situations and not be a part of rehabilitation benefits to reduce pain and help deal with musculoskeletal injuries?

There is much that we will need to know. Here are some things to start asking:

What plans will cover massage therapy?
What is the language in each plan that says massage therapy will be covered?
Is there a definition of medical necessity in each plan around the massage therapy benefits? What does it say? Will massage need to be medically necessary?
Will a prescription be required? (It will need a prescription if it needs to be medically necessary but not sure if it would if it is palliative care, but many elderly people will have many other health issues that may be a contraindication and will need to be OK’d by a doctor and maybe also prescribed by a doctor.)
What will be covered? Will it cover massage for rehabilitation from surgery, injuries or just the palliative care?
Will it cover massage therapy for cancer recovery?
What will the benefits be?
What CPT code will be allowed? 97124 or 97140 are the two main codes allowed now by health insurance.
How many sessions will be covered?
How will medicare be billed?
Will billing insurance make your massage business more profitable? See the formula for figuring it out.

Now What?

Having Medicare recognize that massage therapy should be a part of their benefits is a good first step. Other health insurance companies may follow once they see that Medicare approves of massage therapy. If they are only approving it as a part of palliative care, then we have more work to do in that area. Massage therapy could help insurance companies save money in the area of Pain Management. AMTA at this time seems to be focusing on the pain issues and the Opioid epidemic with their recent report: Massage Therapy in Integrative Care & Pain Management

Massage therapy’s role in integrative health care has become widely accepted in major hospitals and in daily medical practice. A wealth of research has also shown the impact of massage therapy for pain management and relief.

Pain is only one very small part of what massage therapy can help with. As a massage therapist in WA since 1989, I have been able to work with clients and bill their health insurance for many conditions such as:

Headaches, Migraines
Fibromyalgia
Strains/Sprains
Herniated Discs
Neck, Shoulder, Back, hip, knee, foot, hand, forearm, leg pain of all sorts
Tendinitis

Health insurance in WA does not cover massage therapy for stress, depression and anxiety which could be added to the list.

As you may already know, WA State has been billing health insurance for medically necessary massage services since about 1999 with the creation of the Every Category Law that mandates coverage by every category of provider. It was introduced in 1993 and fought by the insurance companies until 1999 when it was upheld by a Supreme Court Decision. (See timeline of events. )

WAC 284-170-270 Every category of health care providers.

(1) Issuers must not exclude any category of providers licensed by the state of Washington who provide health care services or care within the scope of their practice for services covered as essential health benefits, as defined in WAC 284-43-5640 and 284-43-5642 and RCW 48.43.715, for individual and small group plans; and as covered by the basic health plan, as defined in RCW 48.43.005(4), for plans other than individual and small group.

For individual and small group plans, the issuer must not exclude a category of provider who is licensed to provide services for a covered condition, and is acting within the scope of practice, unless such services would not meet the issuer’s standards pursuant to RCW 48.43.045 (1)(a). For example, if the issuer covers outpatient treatment of lower back pain as part of the essential health benefits, any category of provider that provides cost-effective and clinically efficacious outpatient treatment for lower back pain within its scope of practice and otherwise abides by standards pursuant to RCW 48.43.045 (1)(a) must not be excluded from the network.

With the combination of Medicare recognizing massage therapy and the precedent set in WA State, massage therapy is on its way into healthcare – whether we want it or not. There are many issues in being a part of healthcare that we are not prepared for. We do not have enough in the way of advocacy in place to talk to the insurance carriers and legislators who create the laws. We need to be at the table or we will be on the menu.

I have my own ideas on what needs to happen to get massage therapy covered by health insurance from my experience of billing insurance in WA State (billing PIP, workers comp since 1990 and health insurance since about 2000) and working with the local massage associations and being a board member for awhile for WSMTA and now the Political Action Committee in WA State – WAMAH.