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Billing Codes

17 Apr 2021 9:52 AM | Amy Thomason (Administrator)

By Dagmar Growe, LMT

I have recently come across a number of questions regarding billing codes. In my early days of insurance billing, I remember being  told by more experienced therapists about a few numbers to be entered into certain fields of the HCFA form, with no understanding on my part, and possibly theirs, about the meaning of any of them. Some things have gotten easier with electronic billing as pull-down menus offer explanations, for example for “Place of Service” (POS). However, there are 2 codes that are essential to understand:

  • ICD-10 (International Classification of Diseases, Edition 10): This is a numeric expression of a diagnosis -  what we treat. Since it is outside of the scope of practice of massage therapists to diagnose, we will need to have this code supplied to us by a healthcare professional who is licensed to diagnose. Even if insurance policies do not require a referral, we still need an ICD-10 code to fill out the HCFA form and get paid. It is also important to note that some insurances will not pay for certain codes, for example fibromyalgia, myalgia, or certain headache codes. If you get a referral with one of those codes you’ll need to call the doctor’s office and request a different code to be assigned.

  • CPT (Current Procedural Terminology): This is an expression of the “procedure” we are performing--how we treat-- and it determines the amount of reimbursement. In theory, LMTs should be able to bill for any CPT code that covers techniques or procedures which are part of our scope of practice. However, many insurances will only pay for 97124, which stands for “massage, including effleurage, petrissage, and/or tapotement”. Other possible codes include 97140 (manual therapy) and 97112 (neuromuscular reeducation). However, if using these codes, it is of utmost importance to understand what these codes describe, and to document your treatment accordingly. Also, be sure that you can show you have been trained to perform these techniques. If you get audited and your documentation is deemed insufficient you may be required to return insurance payments. More information on codes can be found here.

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