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CPT 97124 - Therapeutic Massage Therapy
(Time-based Code)
CPT Code 97124: Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage, and/or tapotement (stroking, compression, percussion).
This is a therapeutic procedure, a manner of effecting change through the application of clinical skills and/or services that attempt to improve function. This procedure requires direct (one-on-one) patient contact by a physician or licensed therapist.
This is a time-based code billed in units of 15 minutes, using the eight-minute rule when necessary. If the service is provided for less than 8 minutes, it should not be billed to the payor.
Reporting Massage Therapy:
Massage is the application of systematic manipulation to the soft tissues of the body for therapeutic purposes.
Massage therapy may be included as a part of an active treatment plan, with specific deficits and goals, expected outcomes, and stated objective measures used to evaluate the effectiveness of treatment.
Massage therapy goals, especially when used as a service preparatory to another treatment, may include restoring muscle function, decreasing specific stiffness, reducing documented edema, improving joint motion by degrees, or relieving muscle spasms.
Choosing 97124 vs 97140 (It's About INTENT)
From a coding perspective, if the therapist is performing therapeutic massage in order to increase circulation and promote tissue relaxation to the muscle(s), then code 97124.
If the therapist is performing massage as a manual therapy technique in order to increase active pain-free range of motion, increase extensibility of myofascial tissue and facilitate the return to functional activities, and it is provided to a different anatomical region than the manipulation, then code 97140.
Audit Trigger Code:
Payors highly scrutinize the use of massage, particularly if more than one unit of service is billed on the same date and/or if the service is billed for more than three visits. It is important to note that payors only cover massage when medically necessary. Therefore, when prescribed for relaxation, stress relief, and other clinically appropriate, but not medically necessary reasons, the services should NOT be billed to the payor.
Documentation Requirements Specific to this CPT Code:
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Indication (rationale) for the treatment
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Treatment goals associated with the massage;
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Objective measures to measure patient progress towards treatment goals;
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Progression towards treatment goals;
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Which regions, specifically, were treated with massage.
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Ensure that your exam and documentation indicate a subjective loss of mobility, loss of strength or joint motion, pain, spasm, soft tissue swelling, inflammation or restriction, etc. to support medical necessity.
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The treatment plan should indicate a direct functional goal or outcome resulting from this service. An example of a direct functional goal is, "Able to bend over to tie shoes by himself within two weeks."
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These services should be documented by the person actually performing the service, using a clock to time in and out, regions treated, techniques used, and patient progress since the last visit. The daily documentation should be signed and dated by the person performing the service and countersigned by the doctor overseeing or delegating the service.
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CPT 97124 may be considered medically necessary in certain cases. CPT 97124 can be reported and reimbursed when massage therapy, including effleurage, petrissage, and/or tapotement (stroking, compression, and/or percussion) is medically necessary and at least one of the following conditions is present and documented:
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the patient has paralyzed musculature contributing to impaired circulation;
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the patient has excessive fluids in the interstitial spaces or joints;
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the patient has sensitivity of tissues to pressure;
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the patient has tight muscles resulting in shortening and/or spasticity of affective muscles;
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the patient has abnormal adherence of tissue to surrounding tissue;
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the patient requires relaxation in preparation for neuromuscular reeducation or therapeutic exercise; or
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the patient has contractures and decreased range of motion.
(Coding Ahead - CPT Code 97124 - Therapeutic Massage Therapy (2021)
"CPT Copyright American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association.")
https://www.codingahead.com/cpt-code-97124-description-guidelines-reimbursement-modifiers-examples/
HNS Policies: Documentation/Billing
When performed and billed to a payor, modalities/therapies must be properly documented in the health care record and accurately reported using the most appropriate code.
When performed and billed to a payor, modalities/therapies must be medically necessary and consistent with the chief complaint/clinical findings, diagnoses and treatment plan.
Documentation in the health care record must include the rationale for each therapy and must clearly establish the medical necessity for each therapy billed to the payor.
For ALL modalities and therapies, documentation must include:
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Type of modality
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Rationale
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Area of application (specific region treated)
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Setting and frequency (as applicable)
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If time based code, actual time service performed
During the initial phase of care, no more than two therapies or modalities per visit are considered usual and customary.
There should be a reduction in the use of therapies as the patient's condition improves.
Modifiers Needed:
When reporting massage with an E/M Code or with CMT, you must append the code with modifier 59 to make clear the service is distinct or separate from other services performed on the same day.
Importantly, when reporting 97124 to BCBSNC, NC State Health Plan (SHP), MedCost, or any plan which utilizes Zelis edits, and you are also billing a CMT code on the same date of service, you must append 97124 with modifier 59 and also modifier GP. (List 59 first, followed by GP.)
Please click here
for the HNS NCCI Edit - Modifier Help Sheet,
which is a list of therapy codes requiring special modifiers.
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