As I have said before, insurance companies will pay for massage as therapy, but you need to meet their criteria. The info below comes from my experience working with a lot of insurance companies and I can tell you that it is not easy to get them to pay what they should.
Anyone that pays for an auto insurance policy expects to get a discount at some point. Auto insurance companies know this and offer different rewards if you drive safely. Discounts aren’t the only ways you can be rewarded, though. Some insurance companies might offer you bonuses such as cash back on every policy renewal. Whether you’re looking to renew your current policy or are looking for a new company, it’s important to find one that offers perks and discounts.
You want to know how to bill your auto insurance for massage therapy. The first thing you need to do is find out what kind of coverage they offer. If your plan has a massage therapist coverage, then it will cover the cost of the massage. If not, you will have to pay for it yourself.
If the plan offers massage therapist coverage, the next thing you need to do is figure out how much your insurance will pay for each visit. This is usually around $45 per session. You can use this number as a guide when deciding how much to charge patients as well.
Once you know what amount your plan will pay for massage therapy visits, it’s time to set up an appointment with your patient and get started!
Most Insurance Companies Do Not Cover Massage Therapy
Generally, car insurance companies will not cover the cost of massage therapy after the accident. Car insurance can cover your medical bills – or the medical bills of any other people you injured. However, massage therapy does not typically fall under this coverage.
If you live in a no-fault state, then your medical bills will be covered by your personal injury protection (PIP) coverage. If you live in an at-fault state (like most states), then the bodily injury liability coverage of the at-fault driver will cover any medical expenses.
Insurance Companies May Cover Massage Therapy If Prescribed By a Doctor
It’s rare for car insurance to cover the costs of massage therapy. However, it’s not totally unheard of.
Your best option is to get a prescription for massage therapy from a doctor. If a physician prescribes massage therapy to treat your injuries after an accident, then your auto insurance – or the auto insurance of the at-fault driver – may cover the costs of massage therapy.
Some massage therapists work specifically with car insurance companies. Payments are made directly from the insurance company to the massage therapist.
Massage Therapy Must Be “Medically Necessary” and “Reasonable”
To determine whether or not massage therapy should be covered, your insurance company will investigate whether or not your massage therapy is “medically necessary” and “reasonable”.
Is your massage therapy genuinely needed to help you get better? Are you medically required to get massage therapy as a direct result of your auto accident injuries? Or is massage therapy just something that will make you temporarily feel better?
Furthermore, does the massage therapist charge reasonable prices? Is the price of massage therapy similar to the prices charged by other providers in the region? Is the client receiving too much massage therapy? Or is the client receiving a normal number of massage therapy sessions compared to car accident victims?
If you legitimately need massage therapy to make yourself ‘whole’ again after an accident, then it’s possible for car insurance to cover the cost of massage therapy.
Some Drivers Commit Insurance Fraud When Requesting Massage Therapy Coverage
If massage therapy is medically necessary and priced reasonably, then your car insurance company could cover it.
Unfortunately, insurance companies often push back against massage therapy coverage because there’s a huge problem with fraud.
It’s difficult for the insurance company to determine if massage therapy is medically necessary and reasonably priced, so they just refuse to cover it at all.
CBS News, for example, recently covered a story about drivers in Florida illegally claiming massage therapy expenses after an accident. It’s a popular form of insurance fraud:
“Scam artists have found a way to milk this [no-fault car insurance] cash cow with “swoop and squat” car crashes…and in some instances, they even create fake crashes using only paperwork.”
After creating a crash scene, the fraudsters visit massage therapists and other professionals who are aware of the scam:
“The ringleaders, or brokers, organize “spider webs” of chiropractors, massage therapists and fake clinics to provide nonexistent X-rays and fraudulent diagnoses that overwhelm insurers with thousands of claims that are rushed through immediately after the “accident.””
Stories like this are particularly common in no-fault states, where personal injury protection (PIP) coverage is specifically designed to cover the immediate costs after an accident. Scammers take advantage of these systems to rack up fraudulent claims – like for massage therapy.
This is one reason why insurance companies are hesitant to cover massage therapy after an accident.
It’s Rare for Car Insurance to Cover Massage Therapy (But Not Unheard Of)
Generally, car insurance companies will not cover the costs of massage therapy. However, if massage therapy is deemed “medically necessary” and “reasonable” after your accident, then it’s certainly possible for massage therapy to be covered by car insurance.
Ask your doctor for a prescription for massage therapy. Without a prescription, it’s unlikely car insurance will cover the cost of massage therapy.
Why is insurance billing for massage therapists important?
Accurate insurance billing for a massage therapist is important due to maintaining optimized practice and streamlining the revenue management cycle. Billing and coding experts need to follow a guideline provided by HCPCS to use CPT massage therapy coding which can guarantee accurate billing if used efficiently.
Not only this but through accurate billing procedures, the insurance claims for the services rendered can be reimbursed in a timely fashion. This means if you are greatly after optimizing practice revenue, with timely reimbursements, your revenue management cycle is less likely interrupted. Either accurate or inaccurate insurance billing will affect the overall practice of a therapist.
How does medical insurance cover massage therapy?
It is important to understand that not all insurance companies accept massage therapy. This is why it is not always guaranteed that your patients’ insurance will reimburse you back for your services.
For this, it is important to discuss the payment and insurance expectations with your client from the initial contact. Getting financial things discussed before the visit and services will reduce the time consumption at the time of the visit and also when it’s time to reimburse.
Also, it is important to ask the client whether their insurance company covers the services for massage therapy under the plan they have purchased. If yes, then it is also required to check whether the massage therapy is covered by the massage therapist as some insurance plans cover massage from a physical therapist.
Many times when there’s an auto accident, it becomes necessary to remain in contact with the legal manager of your service to cater the insurance for the service they are insured.
Are massage therapies covered by Medicare?
Right now massage therapies and treatments are not covered by Medicare. But there are insurance sources that do cover massage therapies and treatment but they vary from state to state. They are;
- Personal Injury (PIP)
- Major medical plans (Blue Cross, Blue Shield, Cigna, United, Aetna, etc.)
- Workers compensation insurance
It is also essential to understand that just knowing the name of the insurance provider is not enough. A therapist must also need to know the insurance plan and the therapies that the plan covers and determine what vendor the client uses for their insurance service. Before the treatment is started, it is vital to confirm the details with the insurance provider. You can directly contact the insurance provider via the contact number provided by the patient medical card and the policy information.
How can a massage therapist bill the insurance?
A massage therapist can bill the medical insurance, as long as;
- The therapy service is the necessary part of the treatment plan prescribed by a chiropractor, DO, or MO,
- The therapist is licensed
- The therapist has an NPI number. If as a therapist, you lack a valid NPI number, you can apply to get one here.
Who manages massage therapy CPT codes
CPT codes are regulated by the American Medical Association (AMA) and are particularly called Current Procedural Terminology. AMA manages the codes that give the structural and procedural codes that define the services and therapies provided by physicians and therapists across the country.
What are the most common CPT codes in massage therapy?
The massage therapist can bill the insurance by using the following codes;
- 97010 Cold and Hot Pack Therapy
- 97140 Manual Therapy (Advanced Massage Therapy Techniques)
- 97124 Massage Therapy (Basic Swedish Massage)
- Manual 97140 and Massage 97124 are more divided into 15 minutes increments where you can be paid for putting up more time with the clients including tapotement, effleurage, petrissage, percussion, and compression.
- 97140 – Manual Therapy (advanced Massage Therapy Techniques)
- Massage (97124) and manual 97140 also are broken down into 15 minutes increments.