Therapeutic Massage Therapy (CPT code 97124)

        Massage is the application of systemic manipulation to the soft tissues of the body for therapeutic purposes. Although various assistive devices and electrical equipment are available for the purpose of delivering massage, use of the hands is considered the most effective method of application, because palpation can be used as an assessment as well as a treatment tool.

        Massage therapy, including effleurage, petrissage, and/or tapotement (stroking, compression, percussion) may be considered medically necessary if at least one of the following conditions is present and documented:
            the patient has paralyzed musculature contributing to impaired circulation;
            the patient has excessive fluids in interstitial spaces or joints;
            the patient has sensitivity of tissues to pressure;
            the patient has tight muscles resulting in shortening and/or spasticity of affective muscles;
            the patient has abnormal adherence of tissue to surrounding tissue;
            the patient requires relaxation in preparation for neuromuscular re-education or therapeutic exercise; or

            the patient has contractures and decreased range of motion.

97124 Therapeutic procedure, one or more areas, each 15 minutes; massage, including effleurage, petrissage, and/or tapotement (stroking, compression, percussion):

* This procedure may be medically necessary as adjunctive treatment to another therapeutic procedure on the same day, which is designed to restore muscle function, reduce edema, improve joint motion, or for relief of muscle spasm.

* In most cases, postural drainage and pulmonary exercises can be carried out safely and effectively by nursing personnel. If the attending physician determines that for the safe and effective administration of these procedures, the professional skills of a physical therapist are required, coverage may be allowed. Documentation of the severity of the pulmonary condition and referral by the physician must be available.

AOTA objects to the listing of only seven indications for which massage therapy would be covered. For example, the relaxation that occurs with massage therapy is often required prior to the performance of a manual therapy technique to ensure maximum effectiveness of the manual therapy. AOTA would not object to language requiring the documentation to reflect the need for therapeutic massage; however, the proposed limitation to specific conditions is not clinically appropriate. AOTA requests that the language be changed to reflect that therapeutic massage may also be reasonable and necessary for other conditions.

It is not appropriate to bill CPT 97124, massage, for myofascial release. For myofascial release, CPT 97140 should be reported. When reporting or billing for CPT 97112 (neuromuscular re-education) and CPT 97124 (massage), as well as all other physical medicine modalities and therapeutic procedures, the details of the procedure shall be recorded in the medical record, including clinical rationale, anatomical site, description of service, and time (as required by the selected CPT code).

Reimbursement guidelines for physical medicine and rehabilitation services are outlined on the following page.

Therapeutic Procedures (one or more areas)


97110 Therapeutic exercises, each 15 minutes


97112 Neuromuscular re-education, each 15 minutes


97124 Massage, each 15 minutes


97140 Manual therapy techniques, one or more regions, each 15 minutes 

Therapeutic Procedures:

The CPT Manual defines a therapeutic procedure as “a manner of affecting change through the application of clinical skills and/or services that attempt to improve function.”

CPT codes within the code ranges of 97110-97124, 97140, and 97530-97542 require direct (one-onone) patient contact by the provider. These codes contain a time component (15 minutes) and time is recorded based on constant one-on-one-attendance.

It is not appropriate to bill CPT 97124, massage, for myofascial release. For myofascial release, CPT
97140 should be reported. When reporting or billing for CPT 97112 (neuromuscular re-education) and
CPT 97124 (massage), as well as all other physical medicine modalities and therapeutic procedures, the
details of the procedure shall be recorded in the medical record, including clinical rationale, anatomical
site, description of service, and time (as required by the selected CPT code).


Massage and Manual Therapy Exclusion 

Blue Cross will not reimburse providers for massage or manual therapy
services (97124 and 97140). Massage or manual therapy will deny
either as incidental (provider liability) or subscriber liability.

Massages that are provided as preparation for a physical medicine
therapy or chiropractic manipulation are considered an integral part of
the therapy. As such, we will deny it as provider liability. If a massage
is billed alone, then it may be denied as a subscriber contract exclusion.

An independent massage therapist is an ineligible provider. When a
massage therapist is employed and supervised by the chiropractor,
chiropractor should submit procedure code 97124 with a -U7 modifier.

Billing Guide

• DO use modifier 59 on 97140, 97124, and 97112 when combined with CMT and provided to separate body regions

 If you bill manual therapy techniques (97140), massage (97124), or neuromuscular reeducation (97112) on  the same date of service as CMT (98940-98943), and do not append the 59 modifier, YOU WILL NOT BE  PAID. (However, PLEASE NOTE, to bill them separately; they must be applied to separate body regions.  Then, to indicate this, you must append the 59 modifier and use appropriate diagnosis pointers in Box  24E.)

CPT 97124 describes a service that is a separate and distinct service from Chiropractic Manual Therapy codes 98940-98943. CPT 97124 describes work including effleurage, petrissage, and/or tapotement (stroking, compression, percussion) and is based on each 15 minutes of treatment per unit. When using this code on the same day as a CMT code service, it may be necessary to append a modifier-59 (Distinct Procedure). It should also be noted that this therapy procedure attempts to improve function by direct hands on and one-on-one patient-practitioner/therapist contact. All that is stated in this paragraph should be noted in the documentation.

The expected outcomes of massage are also more general in nature and may in fact be what patients can’t tolerate at the more acute stage of their treatment plans. This would include such goals as to decrease pain, decrease muscle spasms, decrease muscle soreness, and increase circulation.

Note: For purposes of secondary Medicare billing only, it is appropriate to bill CPT 97124 in conjunction with a CMT code codes 98940-98942 on the same date of service, provided the treatments are to separate body regions of the spine. In these instances Modifier-59 may be added to the 97124.

This code 97140 continues to suffer from bad and inconsistent guidelines, edits, and laws. The CPT guidelines state that 97140 services are included in the CMT codes (9894-98942) when performed on the same spinal regions as a CMT codes. Also, Medicare NCCI edits categorized 97140 as a component of CMT, unless a modifier (e.g., -59) is used for a different region(s). However, Medicare law prohibits coverage and payment for non-CMT services. Thus, if 97140 is bundled with or into CMT, it would be a violation of Medicare law.

Furthermore, the Medicare relative value units (RVU) do not include any non-spinal services for (e.g., 97140, 97112, 97124 etc.)

Manual Therapy (CPT code 97140)

AOTA requests that the reference to connective tissue massage and therapeutic massage be removed from this code, as massage is appropriately billed under CPT code 97124. To the extent that the reference was intended to include connective tissue mobilization and transverse friction massage as manual therapy techniques, AOTA would support these inclusions.

        Manual therapy includes the following modalities:

            Manual traction may be considered reasonable and necessary for cervical radiculopathy.
            Joint mobilization (peripheral or spinal) may be considered reasonable and necessary if restricted joint motion is present and documented. It may be reasonable and necessary as an adjunct to therapeutic exercises when loss of articular motion and flexibility impedes the therapeutic procedure.
            Myofascial release/soft tissue mobilization, one or more regions, may be medically necessary for treatment of restricted motion of soft tissues in involved extremities, neck, and trunk. Skilled manual techniques (active or passive) are applied to soft tissue to effect changes in the soft tissues, articular structures, neural or vascular systems. Examples are facilitation of fluid exchange, or stretching of shortened muscular or connective tissue. This procedure may be medically necessary as an adjunct to other therapeutic procedures such as 97110, 97112, and 97530.
            Manipulation may be medically necessary for treatment of painful spasm or restricted motion of soft tissues. It may also be used as an adjunct to other therapeutic procedures such as 97110, 97112, and 97530.

NCCI EDIT 

The below CPTs are not paid separately when submit with CPT 97140, USE appropriate modifier.

0213T 0216T 0228T 0229T 0230T 0231T 62310 62311
62318 62319 64400 64402 64405 64408 64410 64413
64415 64416 64417 64418 64420 64421 64425   64430
64435 64445 64446 64447 64448 64449 64450 64461
64463 64479 64480 64483 64484 64486 64487 64488
64489 64490 64493 64505 64508 64510 64517 64520
64530 95851 95852 97002 97004 97018 97124 97530
97750

97140: Manual therapy techniques (e.g. mobilization, manipulation, manual lymphatic drainage, manual traction) one or more
regions, each 15 minutes. 

When reporting the CPT code 97140 in conjunction with CMT codes, there are six criteria that must be documented to validate the
service:
1. Manipulation was not performed to the same anatomic region or a contiguous anatomic region e.g., cervical and thoracic
regions are contiguous; cervical and pelvic regions are noncontiguous

2. The clinical rationale for a separate and identifiable service must be documented e.g., contraindication to CMT is present

 3. Description of the manual therapy technique(s)

4. Location e.g., spinal region(s), shoulder, thigh, etc.

5. Time i.e., number of minutes spent in performing the services associated with this procedure meets the timed-therapy
services requirement

6. CPT code 97140 is appended with the modifier -59 or the appropriate -X modifier