What is the CPT code 97140?

What is medical necessity for 97140?

Clinical Necessity

Every session using CPT Code 97140 should meet the criteria of medical necessity. This means that the billed procedure should be essential for the patient's condition, and there should be clear documentation of why manual therapy is needed.

Does insurance cover manual lymphatic drainage?

Coverage largely depends on whether the massage is deemed medically necessary. For instance, if a doctor prescribes lymphatic drainage massage as part of treatment for a specific medical condition like lymphedema, your insurance might cover it.

Is manual therapy the same as physical therapy?

Manual therapy is a specialty within the field of physical therapy. Traditional physical therapy focuses more on managing and treating the symptoms of the disease process, while manual therapy focuses more on performing biomechanical, tissue-based examination to identify the cause of the disease process.

How many units can you bill for 97140?

Billing in 15-Minute Increments

These 15-minute increments are non-cumulative, meaning you can only bill for full units, not fractions. Example 1: A 20-minute manual therapy session would be billed as one unit of 97140. Example 2: A 40-minute session would be billed as two units of 97140.

Can 97110 and 97140 be billed together?

Since the time for each service is the same, choose either code for 2 units and bill the other for 1 unit. Do not bill 3 units for either one of the codes. Appropriate billing for 40 minutes is for 3 units. Bill 2 units of 97110 and 1 unit of 97140.

What insurance companies cover massage therapy?

What is the CPT code for 60 minute massage?

The CPT code for massage is 97124 which is a timed-based service which is reported in 15 minute increments. There is only one code for all massage (97124) so longer massage services would simply be reported using the proper number of units (e.g., 60 minutes = 4 units).

What can be billed under manual therapy?

In summary, CPT code 97140 allows therapists to bill for timed, hands-on, manual therapy as part of a patient's care plan. Manual therapy has a place in occupational therapy treatment plans as manual techniques can enhance functional range of motion and manage pain for improved participation in daily tasks.

Does Aetna cover CPT code 97140?

A few months ago, Aetna released a new policy indicating they will no longer pay for 97140 (manual therapy techniques) when performed on the same date of service as a CMT code (9894x). This even includes billings where the provider appends the -59 modifier (appropriately or inappropriately).

What is CPT code 97110 used for?

CPT 97110: Therapeutic Exercise

CPT code 97110 is defined as “therapeutic exercises to develop strength, endurance, range of motion and flexibility.” It applies to a single or multiple body parts, and requires direct contact with a qualified healthcare professional.

What type of pain is relieved by manual therapy?

It has been known to alleviate symptoms related to back pain, neck pain, fibromyalgia and pelvic health challenges such as prolapse. Furthermore, it may provide temporary relief from headaches, anxiety and depression.

Does manual therapy include massage?

The two treatment options often overlap -- in fact, many manual therapy techniques include various forms of massage therapy.

What are the 4 main types of physical therapy?

Stretching. Strength training (with or without weights or exercise equipment). Massage. Heat or cold therapy.

What does code 97140 mean?

CPT® code 97140: Manual therapy techniques, 1 or more regions, each 15 minutes (Mobilization/manipulation, manual lymphatic drainage, manual traction)

Is CPT 97140 covered by Medicare?

Medically necessary hands-on MLD is a covered Medicare service and is coded using CPT 97140 for manual therapy.

What is a manual physical therapist?

Manual therapy, or manipulative therapy, is a treatment primarily used by physical therapists and occupational therapists to treat musculoskeletal pain and disability. It mostly includes kneading and manipulation of muscles, joint mobilization and joint manipulation.

Who Cannot do lymphatic drainage?

“It's also important to note that lymphatic drainage techniques are not recommended for people who have a heart condition, kidney problems or cellulitis.”

Why are lymphatic massages so expensive?

Larger areas or those with more lymphatic congestion may require longer sessions, thus increasing the overall cost. For instance, a full-body massage is typically more expensive than a session focusing solely on the legs or arms. Number of Sessions: The total number of sessions needed can significantly impact the cost.

Will insurance pay for massages?

Medical companies cover medical procedures and will not cover luxuries such as massage that is not prescribed by a doctor. If you do not have a medical need for massage therapy and are only seeing a massage for enjoyment, then you will not be covered by medical insurance.