Frank Wu

I use 97140, (Physical Manipulation), which works in Virginia. Try it, and divide it into 15-minute segments.

Clay Cox

Depending on the state that you practice in, you might be able to use 97140.1 bill four units at $25 per unit. In other cases, I use a combination of 99213 every month or so for $60. Weekly billing as best describes my tx: 97250 Myofascial Release at $40, 97265 for Joint Mobilization at $40 again, and 97260 at $40, if I do an Osseous Manipulation. I will bill 97010 for Hot or Ice Packs for $18 when indicated and 97122 for Manual Traction (Occipital / Pelvic Lift) at $35 regularly.

Most companies will not fund tx over one hour in length except when included with a re-exam of an established patient.

Jennifer Albrecht

Here’s how I break down my $95 fee for my (Rolling) services:

Therapeutic procedure 97710 $30

Neuromuscular re-education 97112 $20

Manual traction therapy 97140 $25

Massage therapy 97124 $20

This seems to be working fine here in North Carolina – claims are being covered for my clients.

Diane Stroud

The current accepted PT codes are 97140 for soft tissue and joint mobilization, 97530 for therapeutic activities (this would be good for any movement cues or education), 97112 for neuro re-ed – also good for movement or any tracking you may do with the tissue work -, and 97110 not 97710 for ther.ex. The codes that Clay still uses – 97265, 97250, and 97122 – are no longer valid. Instead, 97140 is used for all manual codes except 97124 for massage. You can use them in any combination you want. Some companies allow three units of code or three separate codes, some allow four. Some reimburse 97110 higher than 97140…. there is no logic to the decisions the insurance companies make. Each of these codes represents 15 minutes of time. So, if you do, as Clay does, four units of one code, that is considered 60 minutes of treatment. I bill in a variety of ways depending on the insurance company.

Clay Cox

So as to add some clarity:

You have to know whom you are billing. Some states work off the Standard CPT and only CPT. Some states and some insurers have their own fee schedule. 97140 is not a valid code in Arizona for Work Comp. but is for some insurance companies in Arizona. Diane is probably referring to the accepted practices in billing in her locale.

None of the codes Jennifer uses are valid in Arizona for work comp. I continue to be reimbursed weekly for billing 97265, 97250, and 97122 – codes that are invalid in Diane’s area.

To know who accepts what, ask for a fee schedule or ask what fee schedule they work from, then work off that schedule to see what best describes your treatment. Generalized code-sharing is usually only a sure thing if you are sharing with someone in the same locale who is billing the same organization.

My suggestion is not to base your income on incomplete and possibly incorrect information. I believe that I should be reasonably compensated for my efforts in my trained field of study and endeavor. I have to educate prospective clients and patients. I also have to educate insurance companies and work comp. organizations as to my work. I cannot talk to them in new age talk. They understand what they have been trained in. Mainly that is their fee schedule. You MUST have a copy of their fee schedule if you want to talk with them, much less get paid by them. You must understand their definitions of the terms that they use in that schedule. If you take adequate notes on your appointments and refer to their fee schedule, you can find services that best describe what you do and what you are allowed to charge for your service.

What this means is that you must talk to the adjuster on the case you are handling. Get their name. When you call, ask for them specifically. Treat them like a human being doing a boring job and help them out. Make their job easier. They don’t like dealing with hassles or problems any more than you or I do. Make it easy for them to do what you want them to do for you. Talk their language and you will get paid more and faster. Talk new age to them and you will rarely get a nickel.

In generalities: I do not believe that any organization or agency will deny you payment for the use of hot/ice packs on your clients/patients. We all do joint mobiliztion and traction as they define the terms. I have serious doubts that you are not “allowed” to use only one CPT code in your practice. Don’t depend on rumors and assumptions for your income. Find out the facts and see how best to apply them to your practice. This approach will allow you to treat lots of folks who would never be able to afford your services and yet are in need.

Lastly, get a hard copy of the fee schedule. Keep track of whom you talk to on the phone. Know your adjuster/s. You will need to prepare your notes in SOAP forma most often have to submit these notes t the carrier, and use their codes to get their money for your services. There is very little variance between agencies and carrier with regard to this process, regardless c whether they are governmental or private insurance carriers. My CPA says that I received $49K+ in 1999 and $53K+ in 2000 ii third party payments. The things that I am telling you are based on facts, not on rumors and assumptions.

Steve Hancoff

I want to add to what Clay wrote. What are being called “PT” codes here are actual’ CPT codes, which means “procedure’ codes. Unless a practitioner is licensed – not certified – by the appropriate stab board, he or she is neither actually legal entitled to bill for nor even to do the procedure. If you are licensed as a massage therapist that’s one thing. But as a Rolfer qua Rolfer, you can get yourself into a legal mess claiming you are doing neuromuscular re education or anything else that has a CP1 code number.

CPT code numbers that start with 97… arc physical therapy codes. You need to be physical therapist (and maybe an OT) to use them. I’m sure many of us, including me have been paid for doing those procedures, but it’s because we have managed to slip through rather than that it’s kosher.

Wiley Patterson

Steve’s comments are quite accurate. For example, joint mobilization is okay for P.T.’s, but manipulation codes are for D.O.’s only. As an M.D., I don’t use the D.O. codes.

Trouble you can create for yourself includes:

1) Medicare charging $2000 per line item in penalties plus the payment back. They often attack one’s license also, or threaten to do so, in order to pressure one to settle according to their terms.

2) Insurance companies dropping a dime to the state, provoking a license review.

3)Legal fees.

If you get approval in writing ahead of doing the work, it is okay to proceed. The letter has to be very detailed, listing which codes and the number of visits that are preapproved. Best that your credentials are known to them a priori. Certainly don’t bill for any work done before such a letter is in hand.

Clients will often encourage you to lean things to their advantage, but I’ve heard that there is no honor amongst thieves. I wouldn’t want to depend on a client’s support when the licensing agency bureaucrat or D.A. states (alleges) that I am a thief and offers the client a whistle-blower reward.

The ugly reality is that the insurance companies have a variety of ways to avoid or postpone paying. Any questioning of your notes, obsessiveness on the HCFA form, syntax while communicating with them, the space between your teeth, etc. will do. I track merely the percentage of collections on the insurance business that I do and long ago gave up any hope that I was dealing with an honest system or that I could expect those companies to do as they convince their clients that they will do.

Whereas accepting assignment will open up Rolfing opportunities to poorer people, it also will open it to people who have unending amounts of energy to dedicate to convincing you of the unreality that the insurance company will take care of it all. I am much busier now that I accept insurance but I don’t take home much more $ than before I accepted insurance. I want to do this in order to learn how Rolfing can interface with the regular community. It takes a full-time employee to handle all the calls and paper work; and I listen to her blow off the frustration of these controlling, manipulative, inherently misleading interactions on a near-daily basis. One source of insanity is the insurance companies themselves and the other is the patients’ desperate machinations to save thirty bucks or so.

The basic concept in a nutshell:

If you deal with an insurance company, you will feel cheated frequently.

Bob Robinson

I second Wiley’s comments. I only take workers’ comp. in California if I have in writing from an adjuster specifying Rolfing, my fee, and the number of sessions approved. Then I simply send them a bill. I don’t get many of these but I have found that this is the easiest way to go.

Also there is a big difference legally between what is called tort law (personal injury/auto accident type) versus workers’ compensation law. The rules are very different.

“Are the fee schedules issued by the State or by the specific insurance company?”

Clay Cox

In Arizona, the Physicians’ Fee Schedule is issued by the state. Insurance carriers very often use a publication called Fee Facts which surveys the country area by area and finds out what the prevailing range of fees for services is. If you use Fee Facts or Work Comp. Fee Schedule’ to base your reimbursement on, you will run into little static from private carriers. It is true that any carrier can pay whatever they want for whatever service is provided to their clients, but that is not the common practice.

I differ with Steve’s opinion. I have been deposed and have testified in court on a number of cases. Defense attorneys are trained very well to find issues that will discredit the plaintiff’s witnesses. I have been a licensed provider for the Arizona State Worker’s Compensation Fund for 20 years based solely on my request. No documentation necessary. I have never been discredited in a court or at a deposition for not being licensed. The questions on this matter are always based on these two issues: are you treating based on your scope of training and are your charges usual and customary? My answer is always yes and I never go to court or a deposition without my resume and a copy of Fee Facts to objectively support my opinion. Also, it is a very good idea to never represent yourself as anything that you aren’t.

What I am sharing with you are my opinions based on my experience.

Misha Noonan

I am in Washington State and, allowed to or not, I use 97140 (Manual Therapy), almost exclusively. It pays consistently $30 per 15-minute unit. I have billed this to PIP insurers and to the Veterans’ Administration, and have been paid in full.

Health insurance companies “usually” payless. CHP (Complementary Health Plans -a preferred provider contractor, i.e., a supplier of preferred providers) asked me if I would be using 97140 when billing for Rolfing services. You bet!! CHP is the contractor for Regence Blue Shield in Washington and Oregon.

In Washington, Blue Shield-Regence pays $25 per unit of 97140 and $18 something for 97124 (massage therapy) … so one can make $28 more billing (rightly or wrongly) 97140 than 97124, and there are some additional codes we can bill that aren’t limited to the usual one hour of tx / 24hr. There is one for exercises, for instance. I’m just getting started in the insurance game here in Washington and am still feeling my way along.

Hint: when getting a scrip from a doc, I coach them. “Please write 97140, Rolling SL and my name, Cert. Rolfer, LMP” I feel that this gives me more documentation, that I am doing what the doc wants done, and that the 97140 the doc is referring to is not PT. As I said, I have repeatedly been paid in full for this code billing, and this is just what I do.

“When you all say ‘per 15-minute units’, what would your bill say? The code four times at $30.00 each? How does this work?

Misha Noonan

My bills read, using the standard HICF (Health Insurance Claim Form) on line 24, from left to right:

“A” Dates of Service: Self-explanatory: the date of Tx

“B” Place of Service: I leave this blank. In box “33”, Physician’s, Supplier’s Address & Phone # I put my mailing label.

“C” Type of Service: I leave this blank too.

“D” CPT Code: 97140, 97124, or whatever you use, goes here.

“E” Diagnostic Code: Get this from the referring physician. What I have done in the past is have the Doc Rx Me, Cert Rolfer &LMP “x” # of Rolfing Sessions CPT code 97140 for Ms. or Mr. “X”, “x” times per week, for “x” weeks.

“F” $ Charges: I put “$120” for four 15minute “units” x $30.00 = $120.00. One “unit” = fifteen minutes

“G” Units: Some codes are not subject to the “unit” time, but offhand I don’t remember which ones.

NOTE: Allan Kaplan cautions that in Washington state, Rolfers are not legally permitted to use the 97140 code, even if some insurance companies do pay us for it; and that technically because of this “legality” if we use 97140, we are practicing outside of our legal scope of practice, hence taking a chance which may not be worth the risk.

Line 28: Total Charge … this is the summation of the daily charges, the charges for the Rolfing txs.

If you get out an HICF form, this will all make sense.

I don’t suggest that anyone use or not use the 97140 code; this is just what I have used and been sufficiently paid as billed.

My experience has been that PIP claims and Federal Workmans’ Comp claims have been paid without a blink once the client / patient, the referring physician, and myself explained what Rolfing can do, how it works, and – most important of all – that the client had recovered quickly when no other form of Tx made a dent in the problem. That is, that the case now was closed and off the claim examiner’s desk. They seem to like that.

Ed Toal

Here is a link to Massage Therapy Associates. They sell a manual on CPT codes specific to bodyworkers. They update the manual annually (as the codes change), and communicate with the AMA concerning controversial codes in order to avoid trouble.

I haven’t seen the book, but it may be a start for those interested in pursuing legitimate relations with the insurance people.

Here’s the link: www.massagecpt.com/manual.asp