CPT codes for massage therapists (2017)

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

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 : Insurance Billing 101 for Massage Therapists. 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.

Back in March 2015, I wrote about the new CPT codes that were supposedly coming in 2017.

Here is the latest news…. there are not going to be major changes in the CPT codes this year. The codes 97124, 97140 will remain in place. The creation of new codes was dropped unexpectedly early last year. We are lacking any reports/updates from the AMTA representative or AMTA on what exactly happened with the proposed changes.

What is happening is that there ARE new evaluation codes that will replace the current evaluation codes – 97001, 97002, 97003 and 97004 (these will be deleted).

Resource: CMS 2017 Annual Update to the Therapy Code List (PDF)

97001 Physical Therapy Evaluation, will be replaced by 3 different codes – 97161, 97162, 97163

97161 PT EVAL LOW COMPLEX 20 MIN Modifier: GP

97162 PT EVAL MOD COMPLEX 30 MIN Modifier:GP

97163 PT EVAL HIGH COMPLEX 45 MIN Modifier:GP

97003 Occupational Therapy Evaluation, will be replaced by 3 different codes -97165, 97166, 97167

97165 OT EVAL LOW COMPLEX 30 MIN Modifier:GO

97166 OT EVAL MOD COMPLEX 45 MIN Modifier:GO

97167 OT EVAL HIGH COMPLEX 60 MIN Modifier:GO

97002 -physical therapy re-evaluation deleted 01/01/2017, replaced with 97164

97004 Occupational Therapy Re-Evaluation –Deleted 01/01/17, Replaced with 97168

So here’s the thing… Can a Massage therapist use, bill and get paid for evaluation codes and can they bill codes that specifically say they are for OT/PT’s?

Also, why are there not codes specifically for massage therapists since massage therapists WERE represented on the CPT code panel for over 10 years while these code changes were being discussed?

For starters, codes do not usually belong to one profession or another according to Susan Rosen, past AMTA representative on the CPT code panel who was not actively involved in the process for the last few years. Anyone who is trained in the procedure and is able to perform the procedure under their scope of practice as outlined in their state laws, should be able to use, bill and get maybe get paid for that code. Her replacement on the CPT code panel was Nancy Parambo of AMTA has not provided any updates on this.

AMTA-WA Government Relations, with input from Susan Rosen of WA State Massage Therapy Association, put together specific language to be added to the Rules regarding the practice of massage therapy. The proposed language reads (from AMTA WA Website (PDF):

(__) “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/patient safety.Evaluation

does not mean diagnosis.(While LMPsare prohibited from diagnosing, evaluation is a distinct function,necessary prior to providing any independently delivered health care service.)

This is PROPOSED Language that is not yet officially accepted. If it does get accepted in 2017, then the next step is to get the insurance companies to allow us to use it and pay us for it or create our own codes for such evaluations. It is not clear WHY this wasn’t being worked on for the last years especially since the new codes specifically say – PT or OT….but none specifically say MT.

If you want to learn more about how to use the codes, you will really want to take a class and start with reading these two sites listed below. Currently, there are no classes, articles or other information on how to use these codes, whether we can use these codes or how to get these codes accepted or if new codes are being created or WTH is going on with codes.

Web PT. Farewell, 97001: How to Use the New PT and OT Evaluation Codes

American Physical Therapy Association. New Physical Therapy Evaluation and Reevaluation CPT Codes

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