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Administrative Manual

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Licensed Massage Therapists (LMPs)

Billing Guidelines
For care to be covered under the member’s benefit, a physician must diagnose a medical condition, which has resulted in functional loss, for which rehabilitation therapy is prescribed. The LMP will be reimbursed for services currently covered under the member’s rehabilitation or neurodevelopmental benefit.

In addition to any prescription and/or required referral, coverage for the services of a LMP is subject to applicable member contract limitations. When the treating LMP submits a claim, it is not necessary to include the patient’s prescription. We do require the prescription to be on file in your office.

Most products cover services performed by a LMP under the outpatient rehabilitation benefit. Therefore, these services are subject to the outpatient rehabilitation benefit contract requirements and limitations.

When billing for massage therapy services, please use the current appropriate CPT codes for all services rendered. Additional billing information is listed below:

  • Units of service must be included on the CMS-1500 claim form.
  • Chiropractic manipulation codes are only payable to chiropractors.
  • Osteopathic manipulation codes are only payable to MDs DOs, ARNPs, NDs.
  • CPT codes, such as E&M codes, are not payable to physical, occupational, speech or licensed massage practitioners.
  • A total of four units of modalities/procedures per date of service are accepted.
    • If no units are listed on the claim, we will assume one unit of service was performed.
  • All licensed providers must bill for any and all services they perform under their own name. LMPs may not submit claims for services performed by another licensed provider. 

Learn more about submitting claims.

8 Minute Rule for Timed Codes – One Service
For services billed in 15-minute units, count the minutes of skilled treatment provided. Only direct, face-to-face time with the patient is considered for timed codes.

  • 7 minutes or less of a single service is not billable.
  • 8 minutes or more of a single service is billable as 1 unit or an additional unit if the prior units were each furnished for a full one.

15 minutes:

  • 8 – 22 minutes = 1 unit
  • 23 – 37 minutes = 2 units
  • 38 – 52 minutes = 3 units

Supplies
Supplies and materials are not separately reimbursed. Supplies provided by the LMP and used during the therapy session are not covered. These are considered part of the provider’s operational overhead.

Services Not Covered

  • Supplies
  • Clean-up
  • Record-keeping
  • Report-writing costs
  • Treatment preparation
  • Member transportation
  • Patient care conferences
  • Application of hot and cold packs

Note: E&M services performed by a LMP are not covered.

Maintenance Therapy
Maintenance therapy means a treatment plan that seeks to prevent disease, promote health, and prolong and enhance the quality of life; or therapy that is performed to maintain or prevent deterioration of a chronic condition. Once the maximum therapeutic benefit has been achieved for a given condition, any additional therapy provided is considered maintenance therapy.

Note: Most products exclude coverage for maintenance therapy.

Accidental Injury

Injury claims must include the following:

  • Date of injury
  • Cause or source of injury
  • Where the injury took place
  • Whether the injury is related to an auto accident or employment

Revised June 2012