HNS Policy 

 

Added 5/1/2019

 

The AMA CPT (Current Procedural Terminology) 2019 edition describes 97124 as "Massage, including effleurage, petrissage, and/or tapotement (stroking, compression, percussion)".

 

Massage is classified as a Therapeutic Procedure which is a time-based service.  A Therapeutic Procedure is defined as "a manner of effecting change through the application of clinical skills and/or services that attempt to improve function".

 

Therapeutic procedures require direct one-on-one patient contact by a physician or therapist and can only be performed by the physician or an appropriately licensed therapist.

 

If it is appropriate to report massage (97124) together with a CMT (98940-98943), the code must be appended with the modifier -59 to indicate a "distinct procedural service".

 

Time Based

All time-based therapies (both therapeutic procedures and constant attendance) are billed in 15-minute increments.  If provided for less than 8 minutes, the service should not be billed to the payor.

 

It is important to recognize that 15 minutes must be spent in performing the pre-, intra-, and post-service work in order to report code 97124.  Common components included as part of Therapeutic Procedures include chart reviews for treatment, setup of activities and the equipment area, and review of previous documentation as needed.

 

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 services is billed for more than 3 visits.  Please remember, as a general rule, 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.

 

Medical Necessity

When performed and billed to a payor, modalities/therapies must be medically necessary, consistent with the patient's chief complaint/clinical findings, diagnoses, and treatment plan.

 

Documentation

When performed and billed to a payor, documentation for massage must include:

 

Diagnoses

Documentation should include specific diagnosis codes linked to the massage procedure.

 

Active Treatment Plan

Documentation must include an active treatment plan with clearly defined objective, measurable goals associated with the prescribed treatment.  Examples of goals might be increasing circulation, improving joint motion by degrees, or for relief of muscle spasms.

 

Rationale

Documentation must include the rationale for the massage and must clearly indicate the prescription of massage is consistent with the chief complaint/clinical findings, diagnosis, and treatment plan.

 

Expected Outcomes

Documentation should include expected outcomes, and the objective measures that will be used to evaluate the effectiveness of the treatment.

  

For ALL modalities and therapies, documentation must include: 

 

•   Type of modality

•   Rationale

•   Area of application (specific region treated)

•   Setting and frequency (as applicable)

•   If time based code, actual time service performed

 

Reminders

All therapies/modalities must be accurately reported using the most appropriate CPT or HCPCS Code.

 

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.