Many insurance companies will cover massage therapy if it is prescribed by a primary care doctor or specialist. This article deals specifically with what to put on the prescription, though you will likely want to provide other information in a separate document for the therapist as well. (See my article on working with a licensed massage therapist for more information.)
The prescription should be written on a regular prescription pad and include the type of massage (“myofascial release” “neuromuscular therapy” or “97140”), the areas to be treated, the diagnosis codes relevant to the prescription, and the duration and frequency of treatment.
There are two main procedure codes used by massage therapists.
97124 covers what most people think of as “traditional massage”. Long, flowing strokes, kneading, and so forth. Many insurance carriers do NOT cover this code. “Massage” is often not specific enough for a written Rx as most insurance carriers consider 97124 to be the “massage”.
97140 covers what most medical massage providers use such as myofascial release and neuromuscular therapy. This is the code that most insurance companies will reimburse for. You can write “myofascial release” “neuromusclar therapy” or “97140” on the prescription. The technical code name is “manual therapy”.
Insurance carriers will need to know why you’ve prescribed massage. Include the relevant diagnosis codes (preferably several). “Medically Necessary” is a phrase that also helps patients get their treatments covered.
Massage is a timed code and is billed for in units. (8-22 minutes of massage treatment is 1 unit, 23-38 is 2, 39-53 is 3, and 54-67 is 4.) Ideally you will include a length of time for each treatment in the prescription such as “4 units” or “one hour”.
Insurance companies also want to have a treatment plan from a doctor for the therapy. For example, “3x/week for 1 week, 2x/week for 1 week, and then 1x/week thereafter for six weeks”. You can also say, “12x 1-hour treatments over 4 weeks”.
The amount of treatments you prescribe will depend upon the severity of the problem, how long the patient has had it (Mrs. Jones with back pain for six months postpartum may take less treatments than Mr. Smith who’s had back pain for fifty years) and what your goals for the patient are. Remember that making changes to tissues takes time and treatments should be more frequent at the beginning of the care plan.
Be sure to sign the prescription.
Each insurance is different, and you may find that the patient needs a new prescription with a specific change of detail or additional information. If you find that they require something different than above, please email me and I will include it here.
Chances are the patient has asked you to write a prescription, but once you realize how well massage therapists and doctors can work together you may find yourself in a position of wanting to recommend and prescribe it without being prompted. Here are some suggestions to assist with patient compliance:
- Explain to the patient why you are recommending the treatment.
- Tell the patient how many sessions you expect them to receive, and that you expect a follow-up appointment to evaluate their condition afterwards.
- Emphasize that you are “prescribing” the therapy.
- Suggest a local professional who you know and trust and reassure the patient that you’ve seen good outcomes with this type of therapy.
- Remind the patient to call that day to set up their first appointment.
- Here is an example: “Mrs. Jones, studies have shown that neuromuscular therapy is an effective, non-invasive, low-risk treatment for low back pain such as yours. I would like for you to receive twelve treatments from a licensed massage therapist. Once you have received all the treatments I’d need you to come back for a follow-up. Here is a prescription and a card for Lizz Pugh, who is excellent and has done great work for many of my other patients. Please call her today to set up your first appointment.”
Please feel free to call me with any questions, or to set up an appointment at your medical office to explore how medical massage therapy in Lakewood Ranch, Sarasota, and Bradenton can help your patients get better outcomes. 941-321-5311