cpt code 97124

(2022) CPT Code 97124 Description, Guidelines, Reimbursement, Modifiers & Examples

CPT code 97124 is a medical procedure code in Physical Medicine and Rehabilitation Therapeutic Procedures using hands, fingers, and thumbs to apply varying degrees of pressure to soft tissues, muscles, and joints. 

CPT Code 97124 Description

Massage specialists and therapists use a variety of strokes and massage techniques on their patients’ bodies for therapeutic purposes. Effleurage, petrissage, or tapotement are the methods used in CPT code 97124.

For example, this massage increases blood flow. This massage also relieves tension and boosts the body’s natural healing processes. In 15-minute intervals, this code is recorded.

97124 cpt code reimbursement

Manual therapy (CPT 97140) and massage therapy (CPT code 97124) are likely interchangeable for Medicare Part B. However, the disparity in income between the two is one of the most visible differences. 

Considering how many massage therapy units are provided per month, it’s easy to see why some facilities prefer to bill one service over another. The provider makes $3.00 more per massage therapy unit, and overcoming is a common blunder. When it comes to 97140 and CPT code 97124, you can only bill one or the other.

Your holistic massage therapy practice’s CPT codes can cover many different procedures. However, you must know which CPT codes are used for each step to avoid revenue cycle management concerns. 

If you accept insurance coverage, your services are more accessible to patients, but the payment process is also more complicated. In addition, the paperwork required is time-consuming, especially if your practice already has a busy schedule.

Soft-tissue massage is a therapeutic application of systemic manipulation. It is because palpation may be used as an assessment and a therapy technique. The most effective way to massage is with the hands. Suppose various assistive technologies and electrical equipment are available.

97124 cpt code

As a follow-up to another therapeutic surgery scheduled for the same day, this operation may be medically necessary to restore muscle function, lessen edema, enhance joint motion, or alleviate muscle cramps.

 Nursing staff can usually safely and effectively execute postural drainage and pulmonary exercises. Therefore, physicians who believe the physical therapist’s expertise is vital to the safe and successful delivery of these therapies may be eligible for reimbursement. 

Additionally, a doctor’s referral is required to document the extent of the illness. One other important aspect of this therapy is the emphasis on one-on-one interaction between the patient and the therapist. 

As a result, massage’s effects may be what patients can’t bear at their most crucial moment of treatment. It may include reducing discomfort, reducing muscle spasms, reducing muscle soreness, and increasing blood flow.

CPT code 97124 can be used with CMT codes 98940-98942 on the same day of service only for secondary Medicare billing purposes if the treatments are for separate spine sections. Modifier-59 may be added to the 97124 in the following situations.

According to the AMA CPT (Current Procedural Terminology) 2019 version, “Massage, including tapotement (stroking, compression, percussion).”

Massage is a time-based service classed as a Therapeutic Procedure. “A method of achieving change through applying clinical skills and services that try to improve function,” according to the definition of a Therapeutic Procedure.

 Therapeutic procedures necessitate direct one-on-one patient interaction by a physician or therapist. Therefore, they can only be carried out by a physician or a properly licensed therapist.

97124 cpt code guidelines

CPT Code 97124 Billing Guidelines

97124 CPT code, massage, should not be used to bill for muscle relaxation releasing, and muscle injury should be recorded using CPT 97140. Unfortunately, code 97140 continues to be plagued by inconsistencies in standards, changes, and laws.

Services coded as 97140 are included in the CMT codes (9894-98942) when conducted on the same spinal areas as those coded as CMT services (9894-98942). Another consideration is that Medicare NCCI revisions categorized 97140 as an essential part of CMT, even though no modifier (such as -59) was used for a separate region (s).

Codes 98940-98943 for Chiropractic Manual Therapy are separate from CPT 97124 because they indicate a different service. On the other hand, Medicare does not cover or reimburse any non-CMT treatments. As a result, it is illegal to combine 97140 with or into CMT. 

Effleurage and petrissage are included in 97124 CPT code, based on 15 minutes of treatment time per unit (stroking, compression, percussion. Additionally, it’s important to note that this treatment method emphasizes the need for one-on-one interaction between the patient and the therapist to improve function. 

Pre-manipulation massages in physical medicine or chiropractic are essential parts of the therapy plan. If the massage is invoiced separately, it may be disallowed as an exclusion from the subscriber contract. Consequently, we will rule it out as a liability of the providers.

Providers such as massage therapists that work independently are ineligible for the program. Procedure 97124 CPT code with the -U7 modifier should be reported by a chiropractor when they engage and supervise a massage therapist.

Insurance companies scrutinize massage, especially if many treatments are claimed on the same day and if the service is paid for more than three sessions. Keep in mind that massage is often only covered if it is medically necessary by the payer. 

When treatments are provided to alleviate tension, anxiety, and other clinically appropriate but non-medically essential reasons, the payer should not charge them. On the other hand, Medicare does not cover or reimburse any non-CMT treatments. As a result, it is illegal to combine 97140 with or into CMT. 

Adding modifier 59 to highlight that the care you give is a separate service from the 97140 is an option if your services meet the criteria. Charging 96523 or CPT code 97124 alongside 97140 is never an excellent idea because these codes describe incompatible operations.

CPT Code 97124 Modifiers

The purpose of CPT code modifications is to make the action and goal of the therapist clear. For example, if the therapist invoices 97140 for both appointments with the same ICD code, it will appear to be duplicate billing.

Therefore, code the first session 97140-59 to explain why there is an apparent discrepancy between these two sessions. 

Two comparable treatments were conducted on the same person in a single day or over a few days, as the -59 modifier suggests. You may get into trouble with your insurance company if you utilize the -59 modification.

When a patient receives chiropractic manipulative treatment in a spinal region defined by CPT codes 97112 and CPT code 97124, the Correct Coding Initiative Edits state that these procedures are not independently reportable (CMT).

Physical medicine and rehabilitation codes can be reported using modifier 59 or XS if these physical medicine and rehabilitation therapies are performed in a separate location from CMT.

However, the modifier XS is more technically true or exact than the modifier 59 since it suggests that the service is separate and distinct from manipulation.

The 59 or XS should only be used for massage and manual treatment during a CMT appointment. Claims denials and payment delays can occur due to billing using incorrect chiropractic CPT codes, which can significantly influence your ability to make money and remain in business.

Modifier 59 can be used in conjunction with physical therapy in some cases. However, physical therapists have the most difficulty with Modifier 59, significantly impacting Medicare compensation. Possibly because of the CPT Manual’s lack of usefulness. 

Understanding NCCI edit pairs are essential to recognizing these instances. An edit pair is a collection of operations performed by therapists to reduce a lengthy story. For example, the payer will infer that one of the services was effectively “baked into” another if you file a claim with both edit codes in an edit pair.

Reimbursement

A big insurance company in Colorado has limited massage therapist claims to CPT code 97124 and established an upper limit on the amount it will pay. The company took this action in reaction to using 95 different CPT codes by Colorado massage therapists.

Those who abused the system were held accountable, and the massage therapists were forced to work for the organization. Unfortunately, a few of our coworkers use the medical payment system for short-term financial gain. 

That affects both the massage industry and those therapists who don’t let self-interest cloud their moral judgment. Instead, massage therapists should become members of a professional association and encourage the organization’s leadership to educate their members about the legal and ethical duties of billing and code-writing. 

We need associations to take a stand and protect their members from unscrupulous billing practices at seminars across the United States.

Example

This example is related to Distinct Procedural Service, for example can be reported using Modifier -59. A patient schedules carpal tunnel syndrome in the hands and wrists, so there is confirmation from the therapist that the insurance company will reimburse their services.

There is a one-hour time slot reserved. The right arm and handwork take much longer than expected because they are slow and meticulous. By the end of the session, no work had been done on the left arm or hand.

After canceling an appointment on the same day, the client is willing to return to therapy on the left side. I’d be making a new appointment for this one. Excellent results can be achieved within fifteen minutes by using this massage.

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