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Does Medicare Cover Massage Therapy

by | Mar 16, 2022 | Medicare

Medicare Guidelines for Massage The...

Massage Therapy – 97124

Yes! Medicare does cover the cost of massage therapy when it is provided by a licensed physical therapist or occupational therapist and when it is determined to be medically necssary.

When does Medicare pay for Massage Therapy – CPT Code 97124?

According to Medicare Part B and CMS LCD L34049

“Massage therapy Massage may be medically necessary as adjunctive treatment to another therapeutic procedure on the same day, which is designed to reduce edema, improve joint motion, or relieve muscle spasm.

Massage chairs, aquamassage tables and roller beds are not considered massage. These services are non-covered.

Massage is not covered as an isolated treatment.

Documentation must clearly support the need for continued massage beyond 6-8 visits, including instruction, as appropriate, to the patient and caregiver for continued treatment.

This code is not covered on the same visit date as manual therapy techniques.
Do not bill massage therapy for percussion for postural drainage.

Supportive Documentation Recommendations for massage therapy

  • Area(s) being treated
  • Objective clinical findings such as measurements of range of motion, description of muscle spasms and effect on function
  • Subjective findings including pain ratings, pain location, effect on function”
Massage Therapy Coverage

CGS LCD L34049 indicates that utilizing massage therapy beyond 6-8 visits will require additional documentation to support medical necessity.

Self Pay Massage Therapy Services

For non-covered massage therapy services, physical therapists would issue Medicare beneficiaries an Advanced Beneficiary Notice before providing this service.

Example of non-covered massage therapy services.

Case #1: A previous patient has been discharged upon completing his plan of care. Now he is seeking paliative massage therapy services delivered by a licensed physical therapist or physical therapist assistant under the supervision of a physical therapist.

This client is seeking massage to prevent the return of symptoms and has been informed of the self pay cost.

Case #2: A current patient is recieving physical therapy services for a diagnosis of low back pain which is contributing to functional limitations associated with lifting from floor to waist, carrying a laundry basket, and vacuuming her home.

Massage was initially used to minimize acute pain and facilitate return to therapeutic exercise. Once you determine massage therapy is no longer medically necessary your patient may choose to self pay for massage therapy during the same session as covered services. The only think to keep in mind is that self pay massage can not be delivered during the same billable minutes as other covered services.

Does Medicare Pay for Medical Massage?

Medicare Part B coverage includes massage therapy CPT code 97124 when it is delivered by a licenced physical therapist or occupational therapist. It may also be provided by a physical therapist assistant or occupational therapist assistant when appropriately supervised by a PT or OT.

Medicare does require the beneficiary also recieve other therapeutic intervnetions under a prescribed plan of care. * Massage is not covered as an isolated treatment.

CPT Code 97124 and CPT Code 97140

CPT Code 97124 cannot be billed on the same day for the same patient as CPT Code 97140 according to CMS NCCI edits. For more information visit APTA’s Common Physical Therapy Code Pairs With PTP Edits.

Anthony Maritato, PT

Anthony Maritato, PT

Private Practice Owner / Physical Therapist

After starting a private practice physical therapy clinic in 2022 with his wife Kathy Maritato, PT, Tony and Kathy grew their practice to five locations across two states.

Now, Tony and Kathy enjoy spending time treating patients in the morning, coaching therapists in the evening, and being home to play with their dog Tucker and 4 boys.