Massage therapy has only one CPT code (97124); while physical therapy has a total of four codes (97161, 97162, 97163, and 97164), the first three being used in tiered billing and the fourth for reevaluation.
DIFFERENCES BETWEEN MASSAGE THERAPY AND PHYSICAL THERAPY CPT CODING
- Physical therapy involves medical massage, checking patients’ physical function (e.g., for someone who had a stroke), and selecting assistive devices for patients who are suffering from mobility issues.
- Physical therapists are highly educated about body systems and usually possess a master’s or a doctorate while a physical therapy assistant holds an associate degree and tends to perform routine treatments.
- Physical therapy, which used to have the code 97001, is now billed based on three tiers using CPT codes 97161 for low-complexity, 97162 for moderate complexity, and 97163 for high complexity. The reevaluation code 97002 is also replaced with 97164.
- However, it must be noted that physical therapists mostly bill patients for therapeutic exercise (CPT 97110) and manual therapy (CPT 97140).
- Massage therapy involves orthopedic treatment; treating osteoarthritis in the knee; making recommendations for lifestyle and wellness; rehabilitation, especially when doing sports massage; and treating the patient’s body holistically.
- Massage therapists don’t necessarily possess a degree but are rather trained through continuing education and short courses.
- Medicare Part B covers massage therapy (CPT 97124), which cannot be billed along with 96523—or the “Irrigation of implanted venous access device for drug delivery systems—nor manual therapy.
MASSAGE THERAPY TECHNIQUES AND CODING
- Massage therapy techniques used by both massage therapists and physical therapists include kneading, skin rolling, wringing, rhythmic percussion, hacking, cupping, or plucking.
- Massage therapy is considered to be one of the popular CPT codes (97124) that are billed by physical therapists because they also perform this service in their role as physical therapists.
- Massage therapy does not seem to have or use other techniques or therapies and is coded only as 97124. However, it involves orthopedic treatment, lifestyle and wellness recommendations, rehabilitation, and holistic body treatments.
- According to Healthline, massage techniques that therapists are likely to be trained to use and offer include Swedish massage, hot stone massage, aromatherapy massage, deep tissue massage, sports massage, trigger point massage, reflexology, Shiatsu massage, Thai massage, and prenatal massage.
PHYSICAL THERAPY TECHNIQUES AND CODING
- Physical therapy involves therapeutic exercises (CPT 97110), such as strengthening, endurance, and flexibility; neuromuscular re-education (CPT 97112), such as re-education of balance, coordination, and kinesthetic sense; gait training (CPT 97116), such as training to use assistive device, weight bearing, and sequencing; manual therapy (CPT 97140), such as joint mobilization, manual lymphatic drainage, and soft tissue mobilization; group therapy (CPT 97150) on land or in water; therapeutic activities (CPT 97530), such as improving functional performance; self-care/home management training (CPT 97535), such as activities of daily living (ADL) training, meal preparation, and use of assistive technology devices; physical performance test or measurement (CPT 97750), such as functional capacity evaluations, Cybex testing, and sport-specific tests; prosthetic training (CPT 97761); and checkout for orthotic/prosthetic use (CPT 97762), which includes evaluation of prosthetic/orthotic devices.
- In addition to the therapies/techniques specific to physical therapy, there is also massage therapy, which is often used by physical therapists as well as manual therapy.
- Physical therapy encapsulates several other CPT codes that are commonly used to treat patients, but massage therapy is just that. It has its own unique set of techniques but does not incorporate others.
- This also speaks to the fact that massage therapists are not as highly educated as physical therapists who focus on body systems while massage therapists use a holistic approach for the overall health of the body and mind.
ANALYSIS: OVERLAP IN PERMISSIBLE TECHNIQUES FOR BOTH IN CODING
- There is an overlap between physical therapy and massage therapy in that physical therapy often uses massage therapy in treating patients, but the opposite is not the same.
- However, while massage therapy cannot be billed in combination with manual therapy (CPT 97140), using Modifier 59, massage therapy can be billed in combination with the re-evaluation of a physical therapy care plan (CPT 97164).
- Manual therapy, which is often used in physical therapy, can also be billed in combination with PT re-evaluation (CPT 97164) using Modifier 59.
- Therefore, massage therapy is a standalone technique and CPT code.
ANALYSIS: MAJOR DIFFERENCES IN CODING
- Techniques used for massage therapy (CPT 97124) and physical therapy (CPT codes 97161, 97162, 97163, 97164) show that they are completely different.
- Massage therapy utilizes skills learned by massage therapists to treat patients holistically (body and mind) and is taken less seriously (techniques compared) than physical therapy, which requires expert knowledge in the body systems to effectively treat patients.
- Insurance companies also make this distinction in the way they treat the billing process for massage therapy. Massage therapies are predetermined for patients to choose from, and insurance companies determine what they can be billed for.
DIFFERENCE BETWEEN MANUAL THERAPY AND MASSAGE THERAPY IN CPT CODING
- Manual therapy (CPT 97140) includes “one or a combination of the following: joint mobilization and manipulation, manual traction, soft tissue mobilization, or compression bandaging.”
- On the other hand, massage therapy (CPT 97124) involves “kneading, wringing, skin rolling, rhythmic percussion, cupping, hacking, or plucking.”
- Although the services are similar, medical facilities tend to earn more from massage therapy rather than manual therapy because they net $3 per unit from massage therapy and tend to bill one (massage therapy) more than the other.
- However, therapists are cautioned not to bill same-day CPT codes for massage therapy and manual therapy because of how similar they are.
- When billing for either CPT codes for massage therapy and manual therapy, the documents must correspond to and clearly state with accuracy the technique used. This is to avoid legal implications in billing the treatment that yields a higher profit than the other.
- Manual therapy and massage therapy are considered linked in CPT coding, so creating an invoice for both will still result in the payment of one service.
- While some services can be billed separately if administered in two separate 15-minute intervals using Modifier 59 (e.g., manual therapy 97140 and therapeutic activities 97530), this can never be done for manual therapy and massage therapy because Centers for Medicare and Medicaid Services (CMS) considers them mutually exclusive procedures.
- Using Modifier 59, manual therapy can be billed in combination with 95851, 95852, 97018 (paraffin bath), 97164 (PT re-evaluation), 97168 (occupational therapy re-evaluation), 97530 (therapeutic activities), 97750 (FCE/performance test), but cannot be billed with 96523 (“irrigation of implanted venous access device for drug delivery systems”) and 97124 (massage).
- Using Modifier 59, massage therapy can be billed in combination with 97164 (PT re-evaluation) and 97168 (occupational therapy re-evaluation), but cannot be billed with 96523 (“irrigation of implanted venous access device for drug delivery systems”).