Please note that this article contains information that is only relevant to American clinics.

Therapists providing treatment under Medicare Part B have likely noticed a similarity between manual therapy (CPT 97140) and massage therapy (CPT 97124) and what the treatment codes entail. But one of the most glaring differences is the difference in payment between the two. On average, one unit of massage therapy nets nearly $3.00 more for the provider—which doesn’t seem like a lot—but when you consider the vast number of units provided per month, it’s easy to see why some facilities are inclined to bill one treatment over the other. In this article, we’ll be discussing what each of these treatments entail, and how you can go about billing them.

The first question on every therapist’s mind before they begin offering a service is “Will the Medicare program pay for this treatment?” In the case of massage and manual therapy, the answer is a resounding “yes.” However, therapists can run into issues if they attempt to bill these two CPT codes on the same day—and the reason for that is the perceived similarities between the two treatments.

Are you familiar with the 8 minute rule? Click here to read about it. 

As per the American Medical Association (AMA), massage therapy (CPT 97124) includes kneading, wringing, skin rolling, rhythmic percussion, cupping, hacking, or plucking. For manual therapy (CPT 97124), the AMA states that it must include one or a combination of the following: joint mobilization and manipulation, manual traction, soft tissue mobilization, or compression bandaging. Thus, if you want to invoice either of these CPT codes, your documentation must specifically cite the above techniques.

As of 2018, the amount that Medicare can pay for one unit of massage therapy is nearly $3 more than one unit of manual therapy. But as a rule of thumb, you should only bill the CPT codes that accurately describe the treatment provided. You should never bill a code simply because it yields a higher payment. Doing this is a sure-fire way to land yourself in hot water.

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Please note that this article contains information that is only relevant to American clinics.

Many American clinics that regularly submit claims to Medicare are well acquainted with the 8-minute rule. But for those of you that aren’t familiar with how Medicare’s 8-minute rule works, we’ve put together this article especially for you. To learn more, continue reading:

What is the 8-minute rule?

The 8-minute rule is a stipulation that allows you to bill Medicare insurance carries for one full unit if the service provided is between 8 and 22 minutes. As such, this can only apply to time-based CPT codes. But, the 8-minute rule doesn’t apply to every time-based CPT code, or every situation. There are a number of conditions that must be met in order for you to bill that code.

Examples of when the 8-minute rule applies

I. If you perform an initial evaluation that lasts 35 minutes and a 7-minute therapeutic exercise, you can only bill one units for the initial evaluation.

Why doesn’t it apply here? Because the initial evaluation is not considered a time-based fee code, and the 7-minutes of therapeutic exercise didn’t surpass the 8-minute threshold. In order to successfully bill for the therapeutic exercise, the provider needs to spend a little more time with the patient.

II. If you perform 30 minutes of therapeutic exercise, 15 minutes of manual therapy, and 9 minutes of ultrasound, you need to add up the total time of the one-on-one therapy provided to determine how much you’ll be able to bill for. In this example, the provider has seen the patient for a total of 54 minutes, and are eligible to bill a total of 4 units. The time spent performing the ultrasound was greater than 8 minutes, so they’re able to bill for one full unit.

If you’re ever in doubt, you can use the chart below to determine how many units you’re able to bill by calculating the total amount of time spent performing time-based fee codes:

Learn more about the 8-minute rule

If you’re interested in learning more about the 8-minute rule, check out the video below: