Progressive Denied Your Manual Therapy? Join the Club!
By now the industry knows that massage therapy services are not reimbursable under Florida PIP Insurance
, regardless of who performs them. However, manual therapy (CPT CODE 97140) modalities are routinely denied by Progressive insurance company on the basis of being massage therapy. Progressive is misguided because manual therapy is not the same as massage therapy and there is a solution: a PIP demand.
First, the relevant statutory provision in Fla. Stat. 627.736(1)(a) reads as follows:
5. Medical benefits do not include massage as defined in s. 480.033
or acupuncture as defined in s. 457.102
, regardless of the person, entity, or licensee providing massage or acupuncture, and a licensed massage therapist or licensed acupuncturist may not be reimbursed for medical benefits under this section.
Massage therapy is defined in Fla. Stat. 480.033 as follows:
3) “Massage” means the manipulation of the soft tissues of the human body with the hand, foot, arm, or elbow, whether or not such manipulation is aided by hydrotherapy, including colonic irrigation, or thermal therapy; any electrical or mechanical device; or the application to the human body of a chemical or herbal preparation.
In PIP, massage therapy is properly coded by CPT 97124 and manual therapy as CPT 97170; while both are forms of manipulation they serve different goals. Manual therapy techniques consist of soft tissue manipulation, joint mobilization, and /or passive range of motion. The goals are to modulate pain, increase joint range of motion, and reduce or eliminate soft tissue swelling, inflammation, or restriction. This therapy also induces muscle relaxation and improves contractile and noncontractile tissue extensibility. The manual therapy has been performed due to limited range of motion, muscle spasm, pain, scar tissue, soft tissue swelling, inflammation and/or restriction. Massage (CPT 97124) describes a service that is separate and distinct than chiropractic manipulation treatment and manual therapy. Massage, unlike those techniques, is totally passive in nature. Massage is applied to a large area often crossing over several types of soft tissue and several areas of soft tissue, and is used primarily for its restorative effects. The expected outcomes of massage are also more general in nature, with greatest impact on such broad factors of pain modulation, muscle tightness, and blood flow to the related tissues. Special thanks to Dr. Marcus Milnes, D.C. (Active Chiropractic in Clearwater), for highlighting this distinction.
No doubt the statutory definition is vague and could arguably be applied to ANY type of manual contact, including chiropractic manipulation or even manipulation under anesthesia. However, these therapies are not denied on the basis of being massage therapy. So why is Progressive singling out manual therapy codes? Answer, because it's similar to massage therapy and it's an excuse for Insurance Carriers to unfairly scrutinize and deny payment for legitimate services.
I should point out that Progressive is the chief violator of 97140 denials and it's not always consistent: pay some here, pay others. A few other carriers deny 97140 on the same basis as Progressive, but never the less, Progressive is the main carrier we see the most denials from. It does not matter if the manual therapy is done by chiropractor, massage therapist, physical therapist, or any qualified provider because the statute only singles out “massage therapy” not services provided by a massage therapist.
As a matter of good business practice, it is best to keep massage therapists out of the treatment of PIP patients because that's a sure way to make sure denials roll in. There is hope. We have done numerous PIP demands on 97140 denials and have been successful in getting those claims paid to providers. While these are small claims and small amounts, for providers they can surely add up. Additionally, I have noticed the majority of these claims settle without the need for protracted litigation which results in speedier payments to providers. Litigation remains costly for insurance companies and these denials lend themselves to retention of pricey coding experts, chiropractic physician experts, and statutory interpretation…all for a small amount of overall exposure to the insurance company in terms of benefits. Easier to simply pay and fight a bigger battle another day.
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Dolman Law Group Accident Injury Lawyers, PA is proud to represent medical providers and independent imaging facilities across Tampa Bay, including but not limited to the counties of Pinellas, Hillsborough, Pasco, Manatee, Sarasota, Hernando, Citrus, Polk, and Charlotte. We are also able to represent any provider across the State of Florida. If you ever have any questions, please do not hesitate to call me at 727-451-6900 or email, [email protected]
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