97124 CPT code
97124 CPT code or massage therapy includes therapeutic procedures that apply therapeutic massage over body muscles and tissues to stimulate the circulatory system, relax muscles, and manage soft tissues. It is a timed code and includes massage techniques such as effleurage, tapotement, and petrissage.
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Occupational therapists may use specialized massage techniques to prepare patients for therapy such as massage for a therapeutic effect to decrease muscle tension or manage scarring on the hand/fingers before participation in therapeutic exercises.
This article will discuss specifics for billing for 97124 CPT code to help you prepare for using this procedure code in your practice.
What is 97124 CPT code
The definition for 97124 CPT code is a therapeutic procedure consisting of massage, effleurage, petrissage, and tapotement (stroking, percussion, or compression) to one or more body areas, every 15 minutes. This is a timed code and intended for use by qualified healthcare providers, including physical and occupational therapists.
Types of procedures covered by 97124 CPT code include effleurage, deep friction massage and tapotement.
Effleurage uses gentle pressure to stimulate muscle relaxation and circulation to warm up a muscle for a more rigorous massage or procedure such as therapeutic exercise. Additional benefits of effleurage include reducing muscle tightness, reducing stress on joints from muscle tension and to reduce muscle guarding after injury or surgery.
Deep friction massage is used to manage scar appearance and elasticity.
Tapotement, also called chest percussion, is when a therapist uses a cupped hand, edge of hand or fingertips to deliver soft blows to the body to stimulate muscle reflexes, and increased circulation.
Medical necessity and coverage criteria for 97124 CPT code
Medical necessity is considered if one of the following conditions is documented.
- Muscle contracture that is limiting range of motion
- Soft tissue adhesions
- If muscle tension or spasticity is limiting optimal participation in daily activities
- Impaired circulation due to muscle paralysis
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CPT code 97124
Total direct, start and end time recorded by the provider with the patient and total treatment time for session.
- Documentation of medical conditions that justifies use of massage therapy intervention (rationale) and good rehab potential to improve with skilled services
- Treatment plans should have specific goals directly related to how technique will improve goals directed at improved functional outcome
- Documentation should be signed and dated by the provider who administered service
- Document location and type of massage therapy technique used
- Documented outcome measures using objective assessments and recurrent measurements to demonstrate improvement with intervention
- Quality of progress (poor, fair or good), and how progress is directly related to achieving goals in treatment plan and improved participation
- CMS documentation recommendations listed on their site include:
- Documentation must clearly justify massage interventions beyond 6 visits including education provided to patient and family for self-management and remaining needs for continued treatment.
- Document patient or caregiver education to self-preform techniques to manage conditions. If continued skilled intervention is required after 6-8 visits, document the reason skilled techniques are still necessary to prevent functional decline after education has been provided.
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97124 CPT code and occupational therapy
Massage techniques used in occupational therapy include procedures listed above to complement other therapy tasks when working through an active treatment plan. Modalities must be documented and billed as a separate code per modality method. Modality must be medically necessary with necessity documented and not billed for the same treatment time as massage therapy to avoid inconsistency with direct, one-to-one treatment time.
Massage therapy techniques can be beneficial in an occupational treatment plan to manage pain, swelling, and range of motion when performing meaningful tasks. Goals for massage therapy techniques are used to prepare the body for another activity such as restoring range of motion or muscle function to increase participation in meaningful activities for the patient.
Maximizing reimbursement for 97124 CPT code
- Common reimbursement issues include incorrect billing due to using the wrong procedure code.
- Common billing errors include using an incorrect code or not respecting billing restrictions reported in Centers for Medicare and Medicaid Services (CMS) guidelines.
- Another common mistake includes billing massage therapy for manual therapy techniques. To ensure billing accuracy, cite the procedure code definition as defined by CMS or the American Medical Association (AMA) and use terminology in your documentation to justify the use of respective codes.
- The difference between using manual therapy, CPT code 97140, and massage therapy, 97124 CPT code is in the desired outcome of the procedure. When the procedure outcome is more of a therapeutic effect to increase circulation and promote muscle relaxation, use 97124 CPT code. If the desired outcome is to increase active pain-free range of motion, manipulate myofascial tissue and facilitate participation in functional activities then use Manual therapy, CPT code 97140.
- Refer to billing guidelines on the American Medical Association website or the Centers for Medicare and Medicaid Services for more information using these CPT codes in your practice.
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Common reimbursement issues include incomplete documentation missing critical elements such as medical necessity information or not having specific goals to justify why skilled techniques are necessary to manage the condition.
- Avoid issues with reimbursement by reaching out to your respective insurance providers to clarify billing for CPT code 97140 and read your provider manuals to understand all requirements associated with billing for this service.
Documentation tips for CPT code 97124
Ensure documentation is complete with start/end times, signature of treating provider, and qualifying information to justify medical necessity.
- Document subjective reports of pain ratings, pain location, and effect on function.
- Document a clear link between massage therapy technique used and specific goals in treatment plan that ultimately increase a patient’s occupational performance.
- Follow rule of eights for timed procedure codes, charging one unit for each 15 minutes.
- Check your respective payor provider manual if a modifier is required for using 97124 CPT code. Some payors may require use of modifier 59 to clarify the service is distinct or separate from other services performed on same date of service. Other modifiers that may be required include (GP, GN, GO, CO, CQ) to document which provider administered service.
Coding restrictions for CPT code 97124
- CMS guidelines state that Myofascial release techniques are billed as procedure code 97140, and not massage therapy 97124.
- CMS currently allows 4 units of procedure code 97124 per date of service with additional units requiring documented justification for full reimbursement to be considered.
- 97124 CPT code is not covered on the same date of service as CPT code 97140 (manual therapy techniques).
- Massage chairs, roller beds, and water massage tables are not considered massage and are not covered under 97124 CPT code.
- 97124 CPT code is also not allowed to be billed when percussion technique is used for postural drainage.
- Additionally, CMS recommends that drainage of interstitial fluid, or Manual Lymphedema Drainage be billed as manual therapy, procedure code 97140. Cite your exact procedure and align with procedure code to ensure billing accuracy.
97124 CPT code and compliance
Compliance regulations include ensuring you have the medical necessity and qualifying conditions documented in your treatment plan before using massage therapy techniques in your sessions.
A qualified provider should provide massage techniques with a record of continued education or specialized certification available in the event of an audit. If an assistant provides the intervention, collaboration with the supervising therapist of the treatment plan should be recorded.
Use caution when billing for more than one unit of massage therapy per date of service and billing for massage therapy beyond six sessions. Ensure medical necessity is justified and that massage therapy is directly related to helping the patient reach their full rehab potential when billing for this procedure.
Conclusion
97124 CPT code is a one-on-one, direct treatment therapy code.
- It must be administered by a qualified healthcare provider.
- 97124 CPT code is a timed code billed following the CMS 8-minute rule, a minimum of eight minutes of direct treatment time for one unit to be billed.
- Must include all necessary documentation to justify clinical rational, clinical skill required and medical necessity.
- Must have specific goals directly related to how intervention will improve measurable functional outcomes.
- Follow up on CMS and AMA guidelines for current recommendations and restrictions when using this code in your practice.
Occupational therapists use massage therapy techniques to help prepare the body for participation, often using the power of massage’s therapeutic effects to allow a patient to perform a task with reduced pain or improved quality of movement. Massage therapy also provides therapists with another tool to help patients meet their goals and achieve greater independence.
How EHR and practice management software can save you time with insurance billing for therapists
EHR with integrated billing software and a clearing house, such as TheraPlatform, offers significant advantages in creating an efficient insurance billing process. The key is minimizing the amount of time dedicated to developing, sending, and tracking medical claims through features such as automation and batching.
What are automation and batching?
- Automation refers to setting up software to perform tasks with limited human interaction.
- Batching or performing administrative tasks in blocks of time at once allows you to perform a task from a single entry point with less clicking.
Which billing and medical claim tasks can be automated and batched through billing software?
- Invoices: Create multiple invoices for multiple clients with a click or two of a button or set up auto-invoice creation, and the software will automatically create invoices for you at the preferred time. You can even have the system automatically send invoices to your clients.
- Credit card processing: Charge multiple clients with a click of a button or set up auto credit card billing, and the billing software will automatically charge the card (easier than swiping!)
- Email payment reminders: Never manually send another reminder email for payment again, or skip this altogether by enabling auto credit card charges.
- Automated claim creation and submission: Batch multiple claims with one button click or turn auto claim creation and submission on.
- Live claim validation: The system reviews each claim to catch any human errors before submission, saving you time and reducing rejected claims.
- Automated payment posting: Streamline posting procedures for paid medical claims with ERA. When insurance offers ERA, all their payments will post automatically on TheraPlatform's EHR.
- Tracking: Track payment and profits, including aging invoices, overdue invoices, transactions, billed services, service providers.
Utilizing billing software integrated with an EHR and practice management software can make storing and sharing billing and insurance easy and save providers time when it comes to insurance billing for therapists.
Resources
TheraPlatform is an all-in-one EHR, practice management, and teletherapy software built for therapists to help them save time on admin tasks. It offers a 30-day risk-free trial with no credit card required and supports different industries and sizes of practices, including occupational therapists in group and solo practices.
More resources
- Therapy resources and worksheets
- Therapy private practice courses
- Ultimate teletherapy ebook
- The Ultimate Insurance Billing Guide for Therapists
- The Ultimate Guide to Starting a Private Therapy Practice
- Mental health credentialing
- Insurance billing 101
- Practice management tools
- Behavioral Health tools
