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CPT Codes for Massage Therapy: CPT Codes & Modifiers


CPT codes are used for reporting and managing records of medical and surgical procedures. CPT codes are used by multiple healthcare specialties including massage therapy providers. This article will discuss the classification of CPT codes and the application of CPT codes in massage therapy. 

What Are CPT Codes?

The American Medical Association (AMA) has developed the Current Procedural Terminology (CPT) system to code for medical procedures and services. This standardized coding system facilitates the exchange of medical records among healthcare professionals as well as used by epidemiologists for research and insurance companies for billing purposes. CPT codes are part of the medical nomenclature, which form the basis of medical documentation and guidelines. [1]

What Are the Types of CPT Codes?

CPT codes are grouped into the following categories. 

Category I CPT codes are used by qualified healthcare professionals to report medical procedures, services, and the use of specific devices. These codes are composed of 5 digits and are released each year. For instance, 29580 is a category I code used for reporting Unna boot, which is the compressive dressing of the lower extremity. 

Category II CPT codes are also known as supplementary tracking or performance measurement codes. The codes are used for describing the quality of care provided by the healthcare professionals and are indicators for the improvement of treatment outcomes. CPT Editorial Panel releases these codes thrice per year. The codes are composed of 4 digits and a letter ‘F’. For instance, the code 2029F represents a complete physical exam of the skin. 

Category III CPT codes are used for tracking new medical technology, procedures, and services. These codes are subjected to assessment and analysis by healthcare providers and researchers. The codes are placed in category I once they are authorized by the US Food and Drug Administration and validated by qualified healthcare professionals. The category III codes are active for only five years, after which they are eliminated if not accepted in category I during this period. [1]

What Are CPT Modifiers?

A CPT modifier is composed of two characters and is used for reporting additional information about the medical services and procedures without altering the definition of the CPT codes. Following are the common CPT modifiers. [2]

  1. Modifier 59 is known as a distinct procedural service. This modifier is used for representing the performance of two or more procedures on different regions of the body during the same visit. 
  2. Modifier 25 is used for reporting separate evaluation and management procedures performed by the physician on the same day. 
  3. Modifier 91 is used when the same physician performs repeated tests on the same day. For instance, 8244 CPT code is used for reporting renin assay whereas 84244-91 is used for indicating two separate renin assays performed on the same patient, by the same health provider, and on the same day. 

什么是按摩疗法?

Massage therapy is part of alternative medicine and is characterized by soft tissue manipulation to bring about relaxation and pain relief. Massage therapy stimulates blood and lymph flow of the affected area and releases the tension from different structures including muscles and joints. Massage therapists obtain a detailed medical history and palpatory information before devising the treatment plan. Massage therapists use different strokes to massage different areas of the body, with a greater focus on areas with primary abnormality. [3]

CPT Codes for Massage Therapy 

Similar to other healthcare specialties, massage therapists are also required to use CPT codes and use the set of guidelines for billing their services. Massage therapy may aim at restoring and maintaining the functional status of the patient. CPT codes for the massage therapy are enlisted in the given table. 

CPT Codes 描述
97010

Describes the use of hot or cold packs during the massage therapy

The cost of hot or cold packs is covered

One or more areas of the body 

An increment of 15 minutes 

97124

Describes massage treatment 

One or more areas of the body

An increment of 15 minutes 

97140

Describes manual therapy for myofascial release 

One or more areas of the body 

An increment of 15 minutes 

97112

Describes neuromuscular re-education 

Used to demonstrate impairments affecting the neuromuscular system

An increment of 15 minutes 

97110

Describes therapeutic exercise for strength, flexibility, and range of movement

Direct contact with the patient 

One or more areas of the body

An increment of 15 minutes 

When more than one therapeutic procedure is performed, the treatment time is combined and billed according to the total units. An example to simplify this statement is given below. 

  1. Therapeutic exercise for 33 minutes (97110)
  2. Manual therapy for 7 minutes (97140)
  3. The total time for both the procedures is 40 minutes 
  4. The total billing units for both the procedures is 3

Massage therapy also includes the use of modifiers for reporting procedures and services. Modifier HT signifies team services and is used when the massage therapist performs a procedure in conjunction with another provider. Modifier 59 can be used with massage therapy CPT codes for reporting separate procedures. The guidelines for using modifier 59 in massage therapy are given down below.

  1. The treatment shall be a part of the diagnosis-related goal
  2. The nature of treatment must be skilled
  3. Manipulation should be performed on a different area on the same day
  4. The description of the involved area of the body and the technique shall be documented
  5. The duration of the treatment (in minutes) shall be recorded [4, 5, 6]

结论 

CPT codes are part of the nomenclature used for billing medical procedures and services. They are widely used by qualified healthcare professionals, insurance companies, and epidemiologists for research purposes. CPT codes are used by massage therapists to report different therapeutic modalities. Multiple CPT codes with their duration are billed as units. Modifiers can be used for indicating additional information that is otherwise not covered by the CPT codes. Modifiers 59 and HT are commonly used in massage therapy for reporting distinct procedural and team services respectively. 

参考 

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865623/ 
  2. https://www.carecloud.com/continuum/modifier-59-25-91-guide-coders/ 
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071543/ 
  4. https://www.amtamassage.org/resources/business-financial-tools/insurance-reimbursement/ 
  5. https://providers.bcbsla.com/-/media/Files/Providers/Professional%20Provider%20Office%20Manual/Section%2058%20Billing%20Guidelines%20Chiropractic%20and%20Physical%20Medicine%20Services%20pdf.pdf 
  6. https://medicarepaymentandreimbursement.com/2010/09/massage-therapy-billing-cpt-97010-97124.html 

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