10 major misconceptions and myths of insurance billing for massage therapists

  1. You must be a “Certified Medical Massage Therapist to accept and bill insurance”. This is false. Insurance companies do not require that you have such a title. You do have to be licensed or certified per your State Massage Licensing Board and/or other State, City and/or County ordinances. An adjuster may ask that you show a specific procedure or modality certification if you are billing for something they feel is outside your scope of practice or training. Those most often questioned are as follows: Manual Lymphatic Drainage, Neuromuscular Re-Education, (not to be confused with Neuromuscular Therapy), Therapeutic Activities, Therapeutic Exercises, Cold Laser Therapy, Ultrasound, Electrical Stimulation or others that are questionable or not in your scope of practice. At that time, an adjuster may request proof of certification by a State or Nationally approved continuing education provider. They do not want to see certificates for a mini or introductory class.  The title “Medical Massage Therapist” or a certificate stating such, is not the ticket to being paid, although it is nice to have as with any continuing education courses as it shows you are continuing your education to become a better therapist, it is NOT required to bill insurance.
  2. What makes massage therapy services medically related?
    While most all massage therapy services can be considered medically beneficial, what makes massage therapy services medical or a medical case is that a treating physician’s diagnoses and order / prescription designating the medical necessity for patient’s condition has been obtained prior to billing insurance for services. To bill insurance an insurance company requires proof of medical necessity when paying an insurance claim.
  3. When working for someone, a massage therapist must follow orders to sign documentation for services they have not viewed or have not performed.
    FALSE, a licensed or certified massage therapist still must work within their scope of practice, ethics and legalities. Many massage therapists have gotten themselves into deep trouble and some even arrested by not using common sense. They followed orders they knew or should have known instinctively did not feel or seem right. Always remember, it is your license on the line! What is worse, get fired and lose your job or lose your license, thereby losing all the time, money and effort you studied to become licensed ?
  4. Since Medicare has ruled that massage therapists are not covered providers then all the other insurance companies will do the same.
    FALSE, we’ve NEVER been allowed to directly bill and be reimbursed by MEDICARE but commercial insurance companies have been reimbursing massage therapists since 1984. Insurance companies do tend to follow some of the Medicare rules, such as some no longer pay for hot & cold packs while some still do, some utilize the Medicare National Correct Coding Institute (NCCI) Edits that include not paying for certain codes on same day, i.e.; 97124 and 97140 as when it is billed by a chiropractor or physical therapist.
  5. It is illegal for a massage therapist to bill for “Medical Massage”.
    This is not an accurate statement. This comes from the term MEDICAL MASSAGE being misused. We do not perform “medical massage” for reimbursement. We perform what we are licensed and trained for, MASSAGE THERAPY and /or BODYWORK. What “techniques” we use whether it’s called medical massage, soft tissue manipulation, myofascial release, neuromuscular therapy or orthopedic massage, to name just a few, are all “techniques” of massage, manual therapy techniques or manual manipulation. The terminology we use and types of techniques we provide are not what we should always bill to insurers. We must bill using available CPT Codes that best match the techniques and modalities that we have learned and that reflect our training and scope of practice.  You should always be concerned and utilize codes in your State’s Scope of Practice including those you have learned that will improve a patient’s medical condition, increase functional capacity and improve activities of daily living and /or helping them to return to work.
  6. A Massage Therapist can accept any type of insurance case.
    This is a sure way to get into trouble and to lose money. Not all insurance companies will reimburse, and not all types of cases will pay a massage therapist. We had hoped that the Affordable Care Act – Section 2706 of that law that prohibits insurance companies from discriminating against alternative care providers (read more here) would have changed things for the better. It has not. Even the employer self- insured plans that fall under Federal Guidelines of ERISA were supposed to be paying us under certain conditions. They are not. That would have opened the doors to over a million more possible clients for us. We all know the insurance companies as well as patients would benefit if therapists performing the work were to be the ones directly reimbursed.  Are you ready to fight the fight?
  7. A massage therapist can bill insurance companies without training and not expect problems such as delays, denials or reductions.
    False, this too is not true. In bygone days, it was very difficult to learn the rules as I had to do, one- step at a time by trial & error. Today it is even much more complicated. Things are changing constantly in the industry. Any mistake raises red flags with insurers making it even more difficult than ever. Insurance adjusters more than ever review files and look for any reason to delay, deny or reduce claims. If you think training is expensive, try learning it the hard way with no one available to learn from. For example, I have received many calls and emails from massage therapists in FL who have lost upwards of $2,300 just because they were late filing a claim, where had they had the proper training, would have known law changes that required timely filing. Stay updated with our newsletters.
  8. A massage therapist can bill an injured worker in a Workers’ Compensation case for balances due or for therapy not paid for by the insurer.
    In all states, to my knowledge, it’s illegal to bill an injured worker if and when you have received authorization (permission from adjuster) to treat them. If you provide therapy to an injured worker and did not obtain authorization after requesting it and documenting that conversation, you may bill them and they can take that up with their work comp attorney, or you can submit claims to their attorney.
  9. As a massage therapist I do not have keep precise records or documentation because it was not in our training or scope of practice.
    Medical cases are also legal cases. A lawyer will tell you, “If it’s not documented, it was not done.” There are many, many guidelines and rules that apply to proper, legal and ethical documentation and way too many to include in this article. (See Documentation section of my manual, Manipulate Your Future) www.massageinsurancebilling.com
  10. One can bill extremely high rates without negative repercussions.
    As it stands, no one can legally set your fees for you. However, insurance companies can set the rates they are willing to reimburse you. Billing much higher rates for medical cases than you bill for your non- medical cases can surely raise red flags and cause all types of repercussions, with patients themselves, with insurance companies, with defense attorneys in court cases and with doctors who refer to you, just to name a few instances.

Disclaimer: This is only a small percentage of the myths & misconceptions I regularly hear about. These apply in most cases and in most states. However, as with anything, there may be exceptions from time to time. I am not an attorney and the information herein is not meant to take the place of qualified legal advice.

By Vivian M Mahoney, LMT, Insurance Consultant

www.massageinsurancebilling.com

Copyright © 1998 revised 2016

9 Comments
  • Jamin Rak
    Posted at 11:53h, 22 November Reply

    Nice post Vivian, the only thing I would add is that as long as you are providing a distinctly different service you can charge a different amount. Apples to apples, oranges to oranges. But that being said, you would need to easily identify those differentials and chart them and include the variances in writing for your client to read and sign. That being said. You can’t charge $39 for a Swedish massage and then charge the insurance $239 for the same service. I recommend people really understand what they’re doing and why before going in with insurance companies. Make sure you actually have the skill set needed to perform said medical massage techniques.

  • Lori Jade Gillis
    Posted at 12:05h, 22 November Reply

    Thank you so much, for the helpful and clarifying facts. I thought for the longest time that I needed bill under a physician’s license in order to accept insurance. This has opened up some opportunity for me. But I was also wondering what are some good websites to go on for more reliable and accurate information like this

  • Mary Derry
    Posted at 12:49h, 22 November Reply

    Great information some of which I already knew but it is always good to hear it again.

  • LoResa Robertson
    Posted at 14:54h, 22 November Reply

    This is valuable stuff and I learned it Years ago from the Best …
    Vivian Mahorney

  • A Robertson
    Posted at 11:03h, 23 November Reply

    Good info Vivian. Can you clarify “extremely high billing rates” compared to rates for non-medical cases? Will you provide a percentage range that would be acceptable to charge higher for billing vs. non-billing cases? That would be helpful.
    Thanks!

  • Susan N Powers (retired LMT from active practice)
    Posted at 12:22h, 25 November Reply

    Special thanks to Steve and Vivian for creating this article. I encourage everyone who reads this to consider taking insurance clients – it is one important revenue stream that is often overlooked or never mentioned at all in most massage therapy training programs. BUT please GET training specific to your STATE – rules and regulations can vary from state to state as well as fee schedules (how much you can charge for a session of medical massage) . Example. In NYS LMTs can bill only for No Fault (auto accident) clients that come to us with a Prescription of Medical Necessity from a MD or DC that includes ICD 10 CODES – diagnosis codes that describe conditions that LMTs can have a direct effect on. And when NYS EDUCATION DEPARTMENT began to require CEUs in order for LMTs to maintain their registration – it specifically EXCLUDED courses that offer specific training in insurance billing from the list of acceptable courses to earn CEUs!!!! I taught insurance billing throughout NYS for 11+ years … and I would still recommend – BEFORE you plunge into accepting insurance clients – that you make an inve$tment in training — your first insurance check will more than cover the cost of one class.

  • Carla Gangone
    Posted at 07:58h, 30 November Reply

    Thank you! Vivian. I’ve followed you from time to time over the years…I appreciate your hard-sought after insights. I consider you one of the most trusted and competent educators in our industry. I haven’t taken the plunge yet to broaden my practice to include insurance billing but when I do you and Steve will be my go-tos! Thanks again.

  • Fresnel. Jean-Louis
    Posted at 12:31h, 19 December Reply

    Very helpful information! Please continue to sent me more. Thank you so much. Have a bless day!

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