What are CPT codes?
CPT (Current Procedural Terminology) codes are a set of codes created by the American Medical Association that list medical procedures and treatments. These codes are a standardized way for providers to communicate with others in the medical field (peers, administrators, insurance companies) and record what techniques and procedures were performed during an appointment. Massage therapists use CPT codes primarily when billing insurance – letting insurance know what they did and for how long.
As you can guess, the CPT codes that massage therapists use most are about massage treatment. There are two CPT codes for massage:
97124 – Massage, including effleurage, petrissage, and/or tapotement (stroking, compression, percussion).
97140 – Manual therapy techniques (e.g. mobilization, manipulation, manual lymphatic drainage, manual traction).
Each code represents a 15 minute increment of service, so LMTs bill for several units within one session. Because the two codes aren’t very distinct (ie, most LMTs wouldn’t be able to say exactly how long they spent doing “massage” versus “manual therapy”), massage therapists should stick to a single code type when billing for an appointment. Don’t, for example, separate an hour session into two units of 97124 and two units of 97140.
Why do the codes only represent 15 minute blocks? Why not an hour? Every procedure in the CPT set is broken down into small pieces, so that providers can mix and match codes. This isn’t very useful for massage therapists, since all we do is give massages*, but other providers (for example, chiropractors) might just give a short massage to their client before an adjustment – and would need to bill accordingly.
These codes are all nice and standardized, and they help make billing pretty simple, but insurance companies don’t always pay us the same favor in return. While, yes, technically the two CPT codes are too similar to distinguish and can be used interchangeably, some companies will only accept one code or the other. Some will accept both, but pay out at different rates (97140 usually earns more).
How do you know which insurance companies want which codes? You could try to read the credentialing contract you receive from each company, but sometimes the language in there can be unclear or misleading. The best thing to do is learn from experience (and take notes!). Try using each code on separate instances; see which one gets reimbursed better. If one claim gets denied, try again with the other code.
I have a pretty good system in place – I use 97140 for all of my billing except for the two insurance companies that only accept 97124. Other therapists have other strategies. Ask around!
*One other code that massage therapists can use, if applicable: 97010 – hot and cold packs (15 minute increment).