Question

The code, 97124, Is specifically for massage but I have read that Insurance will more likely pay for 97140. Could we bill for whichever one pays? I believe that we have to indicate which area is used for CMT and which area for massage. Is it enough to document that or should we indicate it on the claim form with diagnosis pointers? What do you recommend?

Answer

Codes are intended to only represent a specific service and not be interchangeable. A different code can really only be used if a different service is being performed. Massage is “efflurage, petrissage, and tapotement.” Manual therapy includes “mobilization/ manipulation, manual lymphatic drainage, manual traction.” The code should be assigned based on which of these services was performed. From a compliance perspective, this decision has to be made regardless of which code is more likely to be paid. Unless the contract says otherwise the patient can pay for the non-covered service out of pocket. 

Massage (97124) documentation should include location, but it is not required for it to be performed in a separate region from the adjustment, as is the case with manual therapy (97140). It would be great if the different regions for 97140 were indicated clearly by the diagnosis pointers. The claim form is the first line of defense before the payor ever sees the documentation. If you can point the 97140 to a shoulder and the CMT to the low back, it makes it easy to see that the regions were different.