CPT codes for massage therapists

Massage Current Procedural Techniques or CPT Codes are the codes that you need to describe your massage services to insurance companies.  The CPT codes are created by the American Medical Association (AMA).  Here is some information on how massage CPT codes are created on the AMA Website.

The basic Massage CPT codes are as follows:

97124 -Therapeutic Procedure, 15 minutes. One or more areas, including effleruage, pettrissage and/or tapotement, compression, percussion.

97140– Therapeutic Procedure, 15 minutes. Mobilization, manipulation, manual lymphatic drainage, manual traction, one or more regions.

97122– Therapeutic Procedure, 15 minutes. One or more areas, Neuromuscular re-education of movement, balance, coordination, kinesthetic sense, posture and proprioception.

97010 – Hot/Cold Packs

What code you use depends on what training you have and what codes the insurance company will allow.  You choose the code that best describes your training and skills.  Insurance companies usually pay different rates for different codes but you should not pick a code just because you will get paid more.

Because most of these codes are timed codes, you also must include in your chart notes the amount of time you spent on each area.  There is an 8 minute rule (See this document at CMS.gov (PDF) and search for 8 minute rule):

When only one service is provided in a day, providers should not bill for services performed for less than 8 minutes. For any single timed CPT code in the same day measured in 15 minute units, providers bill a single 15-minute unit for treatment greater than or equal to 8 minutes through and including 22 minutes. If the duration of a single modality or procedure in a day is greater than or equal to 23 minutes through and including 37 minutes, then 2 units should be billed. Time intervals for 1 through 8 units are as follows:
Units Number of Minutes
1 unit:  8 minutes through 22 minutes
2 units:  23 minutes through 37 minutes
3 units:  38 minutes through 52 minutes
4 units:  53 minutes through 67 minutes
5 units:  68 minutes through 82 minutes
6 units:  83 minutes through 97 minutes
7 units:  98 minutes through 112 minutes
8 units:  113 minutes through 127 minutes

Evaluation and Management Codes

In 2017, new evaluation and management codes were created with physical therapists in mind. The new codes specifically say physical therapy. The fact is that codes do not belong to any one profession. If your scope of practice allows you to evaluate and manage clients, then you should be able to use these codes. Most states massage scope of practice definitions do not allow massage therapists to use this code.

AMTA-WA worked with the Board of Massage and legislators to update their scope of practice laws to include a definition of evaluation. WAC 246-830-005 says:

(10) “Evaluation” means the assessment of soft tissue in order to facilitate decision making regarding effective forms and techniques of massage, and identifying cautions and contraindications to ensure client or patient safety. Evaluation does not mean diagnosis.

Using these codes does not guarantee you will be paid for the codes. Each plan varies as to what codes they will pay for.

Centers for Medicare & Medicaid Services Chart

97161 – Physical therapy evaluation: low complexity, requiring these components:
• A history with no personal factors and/or comorbidities that impact the plan of care;
• An examination of body system(s) using standardized tests and measures addressing 1-2 elements from any of the following: body structures and functions, activity limitations, and/or participation
restrictions;
• A clinical presentation with stable and/or uncomplicated characteristics; and
• Clinical decision making of low complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome.
Typically, 20 minutes are spent face-to-face with the patient and/or family

97162 – Physical therapy evaluation: moderate complexity, requiring these components:
• A history of present problem with 1-2 personal factors and/or comorbidities that impact the plan of
care;
• An examination of body systems using standardized tests and measures in addressing a total of 3 or
more elements from any of the following: body structures and functions, activity limitations, and/or
participation restrictions;
• An evolving clinical presentation with changing characteristics; and
• Clinical decision making of moderate complexity using standardized patient assessment instrument
and/or measurable assessment of functional outcome.
Typically, 30 minutes are spent face-to-face with the patient and/or family

97163 – Physical therapy evaluation: high complexity, requiring these components:
• A history of present problem with 3 or more personal factors and/or comorbidities that impact the
plan of care;
• An examination of body systems using standardized tests and measures addressing a total of 4 or
more elements from any of the following: body structures and functions, activity limitations, and/or
participation restrictions;
• A clinical presentation with unstable and unpredictable characteristics; and
• Clinical decision making of high complexity using standardized patient assessment instrument
and/or measurable assessment of functional outcome.
Typically, 45 minutes are spent face-to-face with the patient and/or family.

97164 – Re-evaluation of physical therapy established plan of care, requiring these components:
• An examination including a review of history and use of standardized tests and measures is required;
and
• Revised plan of care using a standardized patient assessment instrument and/or measurable
assessment of functional outcome.
Typically, 20 minutes are spent face-to-face with the patient and/or family

Massage Therapy Coding Tips:

• Only use one of these codes on a bill; 97140 or 97124. Don’t use both.
• 97010 hot/cold packs is now mostly ‘bundled’ with 97124 or 97140 meaning you might not be able to bill a separate fee for this service.
• If you are paid for using an improper code, it doesn’t necessarily mean it is acceptable.  You are responsible for billing the proper codes.
• Questionable codes are: 97110, 97112, 97530, 97001-97006 (which are codes dealing with evaluation and re-evaluation).  Once in awhile you may find a company that will pay for those.  It is still not clear whether a massage therapist is able to use those codes.
• Codes are not restricted to one group of providers.  Some try to say that the codes listed above are physical therapy codes.  Any procedure code may be used by a qualified provider.
• Know your codes.  Know your billing procedures.
• Have Patience!
• You have to know more than just the codes – you need to know how to use them and how to bill to get paid by insurance.  To learn more about billing see my book :  Massage Insurance Billing: Healthcare Integration and Advocacy.     It is important for more massage therapists to start billing insurance for medically based treatments.  We currently need more people involved so they know what is happening and who will start taking a stand to get massage therapy the recognition and respect that it deserves.

There is way more to billing for massage than just knowing the codes. You will need to know how to use the codes and which codes to use as well as how to chart for each code to show medical necessity. I have much more explained in my book – Massage Insurance Billing (available in PDF, Kindle and Paperback)