Searching for the right way to report a therapeutic massage? CPT code 97124 can do this job. Massage therapists are in high demand this year as more and more people are turning towards this type of therapy for stress management.
But the real question is, do insurance payers cover every type of massage therapy? The simple answer is no. Payers only reimburse for massage services if they are medically necessary. So, what kind of service does the 97124 CPT code cover? Read on to find that out!
CPT Code 97124 – Description
CPT code 97124 simply represents a therapeutic massage to relieve pain or reduce inflammation in one or more areas, each lasting 15 minutes. To be more specific, therapists use this code when they apply firm or light pressure on certain areas of a patient’s body using different techniques, such as:
- Effleurage (a gentle massage technique using fingers and flat hands)
- Petrissage (applying deep pressure via kneading and squeezing tissue and muscles)
- Tapotement (a more aggressive technique involving rapid tapping, slapping, and cupping of the massaged area)
The key reasons for this type of service? To restore or improve blood circulation and reduce muscle stiffness. In short, this code is commonly used in rehabilitative settings and is billed in 15-minute units.
Scenarios Where CPT Code 97124 is Applicable
Need a more concrete explanation for this code? Here are two realistic examples of a therapeutic massage where CPT code 97124 is applicable:
Massage Therapy to Reduce Muscle Pain
Fibromyalgia affects around 2% of the adult population in the U.S., 4 million people to be exact. Healthcare providers typically use a combination of treatments to manage this long-term condition. This includes massage therapy.
So, for this example, suppose a 36-year-old woman suffers from chronic fatigue, muscle pain, and anxiety due to fibromyalgia. She visits a physical therapist with this problem. The healthcare provider evaluates her condition and learns that the muscle pain is mainly around her upper back.
Therefore, he performs a Swedish massage on those muscles to provide some pain relief. Since the session lasts 15 minutes, he uses CPT code 97124 to bill for this service.
Therapeutic Massage Post ACL Reconstruction
Anterior cruciate ligament (ACL) tears are quite common among athletes, with basketball being the riskiest sport for both men and women. So, for this scenario, let’s consider a 23-year-old female national basketball player in post-operative ACL rehabilitation.
Since a therapeutic massage is part of her treatment plan, the healthcare provider spends 30 minutes on specific body parts. He uses different techniques to reduce muscle tightness and then bills two units of CPT code 97124.
Applicable Modifiers for CPT Code 97124
You can use the following modifier with CPT code 97124:
Modifier 59
Did you offer another service to the patient on the same day as the therapeutic massage? If the therapy is distinct and separately identifiable from that service, append modifier 59 to CPT code 97124. This modifier can help you bypass NCCI bundling edits. However, avoid misusing it. You can also use more specific codes, like XE, XS, or XP (wherever possible), to specify why the massage service was distinct.
CPT Code 97124 – Billing & Reimbursement Guidelines
You must document and bill this code accurately to avoid denials. A simple way to do that is to follow the billing and reimbursement guidelines for CPT code 97124 mentioned below:
Use CPT Code 97124 for a Therapeutic Massage
You must confirm that the massage is therapeutic before billing it with this code. Remember that the 97124 CPT code does not cover relaxation-based services. Therefore, use it only if you have massaged a patient’s muscles or tissue using your fingers, palms, or thumbs to reduce pain or muscle tension.
Bill in 15-Minute Increments
Keep in mind that CPT code 97124 is time-based and is reported in 15-minute increments. This does not mean that you cannot bill a 12-minute session. You can use the Medicare 8-minute rule when necessary. For example, if you massaged a patient for only 10 minutes, you can bill 1 unit of this code. For better understanding, you can look at the following billing units:
- 1 unit = 8 to 22 minutes
- 2 units = 23 to 37 minutes
- 3 units = 38 to 52 minutes
Document the Important Details of the Therapeutic Session
How will you apply and justify billing units if you haven’t documented the duration of the session? You must record every important detail of the massage service you provided to a patient to avoid denials, including:
- Clinical justification for the massage (e.g., reduced blood circulation, edema, soft tissue adhesions).
- Targeted body areas.
- Time spent massaging each specific area (in minutes).
- Techniques used.
- Treatment response.
Check Payer-Specific Requirements
Finally, check the individual payer requirements to verify their specific rules. The main reason for this is that some insurance payers may limit CPT code 97124, while others may classify it as non-covered. For example, Medicare Part A and B do not cover massage therapies. Therefore, complete this step before billing for this code to avoid unexpected delays.
Summary
Was our blog helpful? CPT code 97124 is a one-on-one therapeutic procedure code. It involves massage therapy via three distinct techniques to improve blood circulation, relax muscles, and stimulate soft tissues. However, many people confuse it with CPT code 97140.
The primary difference between the two codes is the intended outcome. While 97124 covers massage techniques for relaxing muscles and restoring blood circulation, the 97140 CPT code specifies manual therapy for improved function.
We have tried to explain the appropriate application of this code in our blog. But if you want to avoid coding altogether, you can choose our physical therapy billing services. Let our experts handle your therapeutic claims.
