Does My Insurance Cover Massage?

You may have to do a little paperwork, but for most folks, the answer is yes!

At our office it is common for clients to have their therapy covered by insurance. This is because we provide our clients with the proper CPT codes, invoicing and SOAP notes from their appointments. If you want to learn how to get your appointments covered by your insurance read this entire article.

ATTENTION: Just to be clear, we only provide invoices and SOAP notes to our clients and they are responsible for obtaining reimbursement. You will be required to pay for your service in full at our office. We do not directly accept insurance! We provide you with the information and paperwork necessary to be reimbursed.

To determine if your insurance covers massage therapy, follow these steps:

• Review Your Policy Documents: Carefully read through your insurance policy documents, particularly the sections that outline coverage for complementary and alternative therapies. Look for any references to massage therapy or manual therapy.
• Contact Your Insurance Company: Call your insurance company’s customer service hotline. Speak to a representative and inquire about coverage for massage therapy. Ask about any specific requirements, limitations, or conditions for coverage.
• Ask About Codes: If your insurance covers massage therapy, inquire about the specific CPT codes or billing codes they require for reimbursement. This information will be necessary when submitting claims. We will provide you with the codes we know, but it never hurts to ask if they are aware of what might work best for you to have a successful reimbursement.
• In-Network Providers: Ask your insurance company for a list of in-network providers who offer massage therapy services. Receiving treatment from an in-network provider may increase the likelihood of coverage. We are likely not in network, but we have had clients finagle their way around this.
• Pre-Approval: If required, obtain pre-approval or pre-authorization for massage therapy sessions. This ensures that the service is deemed medically necessary and covered under your policy. Yes, this means a few hoops must be jumped through. It will be worth it! Good news is, not every policy requires pre-approval!
• Medical Necessity: Some insurance plans require a doctor’s referral or prescription stating that massage therapy is medically necessary for your condition. Check if this is a requirement for your coverage. It’s pretty standard for most insurance policies. Similar to getting approved for physical therapy. If you are already on muscle relaxers, any sort of anti-inflammatory for pain, pain pills, receiving corticosteroids shots, currently in treatment for physical therapy or have any other documented pain or injury. It should be easy to get approved for our services.
• Claim Submission: If you receive massage therapy and your insurance covers it, make sure to gather all necessary documentation, including receipts and any required forms. Submit the claim to your insurance company according to their guidelines. Providers typically ask for SOAP notes, invoices and CPT codes associated with the service.
• Check for Exclusions: Review any exclusions or limitations in your policy related to massage therapy. Some policies might have specific restrictions on the types of massage or conditions that are covered.
• Appeal if Necessary: If a claim is denied but you believe it should have been covered, you can appeal the decision. Follow the appeals process outlined by your insurance company. We have had several clients who were denied initially and followed the appeal process with success.

Remember that insurance coverage can vary significantly between different plans and providers. It’s important to communicate directly with your insurance company to get accurate information about your coverage for massage therapy services. Additionally, be prepared for potential out-of-pocket costs even if massage therapy is covered, as deductibles, co-pays, and other factors can come into play. Some providers may approve a certain amount of massages per year, but only reimburse the client for 50%.

Massage Therapy and Manual Therapy CPT Codes:

• 97124 – Massage Therapy: This code is used for therapeutic massage interventions, including effleurage, petrissage, and other manual techniques to address musculoskeletal issues.
• 97140 – Manual Therapy Techniques: This code covers manual therapy techniques such as soft tissue mobilization, myofascial release, and joint mobilization.
• 97139 – Unlisted Therapeutic Procedure: This code is used when a specific procedure is performed that doesn’t have a designated CPT code. It may apply to certain specialized soft tissue therapy techniques.
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• 97530 – Therapeutic Activities: While not exclusively for manual therapy, this code can be used when therapeutic activities involve hands-on techniques to promote function and mobility.
• 97110 – Therapeutic Exercises: Used for active or passive exercises that may be part of a rehabilitation program for soft tissue injuries.
• 97112 – Neuromuscular Re-education: This code can be relevant when myofascial release is combined with exercises that focus on improving neuromuscular control.

In most cases, you will be using one of the first three codes along with how many minutes your session was. You’ll also need to provide the invoice and soap notes we send to you after your appointment.

If you need more information we are happy to chat with you by phone call, text message or email. Again we do not submit this information for you and we will not speak to your insurance provider in any way on your behalf.

Phone 📞 727-580-3160

Email 📧 [email protected]