Can I Bill an Insurance Company for Massage?

Yes you can in certain cases and with certain types of insurance.  It’s a bit of a slippery slope though. Insurance companies may be willing to reimburse you if you are willing to follow their guidelines and keep good records.  You’ll need to be patient with the process at the start which may be challenging.  You should reach out to various companies and speak to a benefits representative to determine if they reimburse for massage therapy.  With information readily available on the internet you could probably perform an easy search online to find insurance carriers that cover massage therapy.

In most states Massage Therapists can bill and be reimbursed directly by No Fault Insurance for massage therapy treatments or manipulative therapy.  As these clients are injured during a car accident the types of injuries suffered are often best served by bodywork.  No Fault may also negotiate a specific rate to reimburse for massage therapy.  Also Workman’s Compensation will often reimburse for massage therapy prescribed when people are hurt on the job.  Both options require the therapist to learn about the necessary paperwork and guidelines specific to each.

Here are some things you’ll need to find out before billing insurance:

  • How to find out if massage will be covered and what you need to do to get paid
  • How to do a thorough intake with clients
  • How to fill out the billing form
  • What CPT codes you can use
  • What to charge for your services
  • What the prescription will need to say
  • How to do SOAP charts that show improvement for clients and track their progress
  • How to do progress reports
  • How to track bills and payments
  • What to do if you don’t get paid
  • How to get referrals from doctors or other health care professionals

Massage Therapists can also become approved providers of certain health insurance companies or wellness focused networks (these are often private networks that provide  resources and access to services for their clients).  This usually involves an application and approval process (possibly a site visit).  Once approved you are given access to a large number of potential clients but there may be a trade off such as you agree charge a lower price than your normal fee to these particular clients.

A very successful way to get reimbursement for massage therapy has been through FLEX spending accounts that many companies and organizations offer employees to afford various medical costs not covered by an insurance plan.  Of course this reimbursement is paid to the client with the assumption that they paid for services at the time of treatment.  In the past what I have done is generate what’s called a Superbill for a client to submit to their Human Resources Department for reimbursement through the FLEX account.  The Superbill  lists a diagnosis code provided by a physician (this should be provided through a prescription specifically for massage/manipulative therapies which includes the diagnosis code which the therapist should keep on file) and treatment codes related to the type of manipulative techniques used to treat the complaint (trigger point therapy, myofascial release, stretching, friction, even muscles can be coded).   Also a summary of my intake and treatment are provided on the Superbill.

What are these codes being mentioned?  The diagnosis code provided by the prescribing healthcare professional is known as an ICD-9 code. The codes provided by the massage therapist are Current Procedural Terminology (CPT) codes.  These codes were determined by the American Medical Association and they identify services rendered by the manual therapist.

I sent my mom to a medical billing and coding class so she could learn all the codes necessary to generate these documents for me in my private practice.  She would take my hourly rate and break that down  between the various techniques I utilized and itemize each on the Superbill.  Each CPT coded technique has a dollar value associated to it.  I provide the Superbill to my client who pays me my fee at the time of service and then they go to their HR department or insurance company and try to get reimbursed.  Any massage therapist can take a CE medical billing and coding course to learn some of the ins and outs of billing and coding.  There are also books available for massage professionals.

Direct reimbursement from an insurance company is possible but challenging even if massage has been prescribed and the person has a diagnosed medical condition.  More opportunity may be on the horizon as consumers openly request more wellness opportunities as part of their healthcare options and larger health insurance companies answer with access to complementary therapies.

–Ericka Clinton, LMT

Sources: Wikipedia, MassageMag.com

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