Friday, November 25, 2022

Does Medicare Cover Massage Therapy

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Medicare Guidelines for Massage Therapy as A Covered Service 97124 #MCRHybrid

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Are massage chairs covered by insurance?

If you already used your deductible and are looking to have your insurance company cover a massage chair’s cost, this the answer is typically no. Massage chairs typically do not have an insurance medical code or DME which means they cannot be covered by insurance.

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What equipment does Medicare pay for?

Durable medical equipment is reusable medical equipment, which includes items like walkers, wheelchairs, or crutches. If you have Medicare Part B, Medicare includes some medically necessary durable medical equipment if your physician or treating practitioner prescribes it for you to use at home.

Having your health insurance plan pay for a new massage chair can be challenging but for many it is possible to get your chair or at least a part of the cost covered under certain benefit plans.

Because the health insurance market is so strict on what is and is not covered, you might have to work to get your plan to cooperate. Even if your insurance wont cover a massage chair’s cost, you might have other options for offsetting the cost of this valuable purchase.

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Using a New Massage Chair to Help Meet Your Deductible

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Medicare Part B Only Covers Certain Types Of Therapy

Medicare Part B pays for certain medically necessary forms of therapy, including some physical therapy, occupational therapy and speech-language pathology services.

In some cases, Medicare may also cover chiropractic services, but only if it’s considered medically necessary to correct a subluxation of the spine.

Even if a therapy service is covered by Medicare, there are annual coverage limits that may limit how many times you can get certain therapy services per year. If you go beyond the annual coverage limit and do not receive an exception, you will be responsible for the full amount of the service.

What If Your Massage Isnt Covered

If your massage therapy isnt covered by your insurance, consider these options to help you find and receive affordable services:

  • If you have a health savings account , you may be able to use it to cover massage costs if it qualifies as medically necessary. Learn more about HSAs and flexible spending accounts .
  • Contact local massage schools to see whether they offer massages at a discount.
  • Ask for discounts where you get your massage services.

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Are Massages Covered By Insurance

With many people turning to massage therapy as a medical treatment, it seems that health insurance should cover massages. However, not all policies do.

For example, Medicare does not cover massage therapy, so you will likely be responsible for 100% of the costs if you seek this treatment. Even if your health insurance provides coverage, there may still be limitations.

The definition of massage therapy may vary, depending on the insurer. That definition of massage, and the reason youre getting one, will likely determine whether insurance will cover it.

If massage treatment isnt covered in your policy, be sure to ask about alternative options. Its also a good idea to discuss them with your doctor.

Risks Of Massage Therapy

Does Medicare Cover Chiropractic Care?

Risks of massage are rare, but can include:

  • Nerve injury
  • Blood clot
  • Bone fracture

You may need to avoid getting a massage if you have a bleeding disorder, burn, open wound, deep vein thrombosis, fracture, severe osteoporosis, or severe thrombocytopenia. Also talk to your doctor about whether you should get a massage if you are pregnant, have cancer, or have unexplained pain.

When getting a massage, be sure to speak up and let your therapist know if anything is hurting or uncomfortable. Most therapists will ask you whether the amount of pressure is okay.

Dont use massage therapy as a substitute for medical care. Be sure to see a doctor if you have persistent health problems.

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Natural Therapy Rebates Under The Microscope

In March this year, the Government announced it was reviewing the subsidies offered through private health insurers. The argument is that rebates should only be paid if the modality has a scientific base.After the review, the Government will continue to award a rebate to therapies that have demonstrated an evidence base. This is expected to occur from 1 January 2014.

Originally published on Jul 25, 2013

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Does Medicare Cover Laser Treatment For Toenail Fungus

Seniors who have chronic medical conditions or severe underlying conditions such as diabetes and immunodeficiency problems are commonly prone to get toenail fungus. If a toenail fungus is left untreated, it can cause serious issues such as pain, discomfort, and even inability to walk. One of the ways to treat this condition is through laser treatment.

If this is a treatment you are considering, one common question you may have is Does Medicare cover laser treatment for toenail fungus? In this article, we answer that question in clear, plain English. You will also find the average costs of laser treatment for toenail fungus and other helpful info.

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Can Medicare Part D Help With Your Chiropractic Care

Medicare Part D, like Part C and Supplement plans, is offered by private insurance companies. This part of Medicare is specifically tailored to cover prescription drug costs.

As many people who seek chiropractic care are suffering from chronic pain issues, chiropractors may partner with local physicians to handle pain management care together.

So, while chiropractors may not be able to prescribe you directly with prescriptions, having your pain management physician be in touch with your chiropractor can make things a lot easier on your end. Part D will most likely cover prescription drugs that are prescribed by your physician to treat your condition.

Massage Therapy Vs Other Types Of Therapy

Medicare Coverage of Pelvic Floor Physical Therapy Occupational Therapy

While massage therapy still isnt covered by Original Medicare, other therapeutic treatments such as physical therapy and occupational therapy are covered by Medicare Part A and Medicare Part B.

Physical and occupational therapy are effective treatments for people suffering from physical disabilities, mobility issues or injuries. Unlike massage therapy, however, these treatment methods are typically short-term, rehabilitative solutions for restoring strength and movement.

Original Medicare pays for 80 percent of the Medicare-approved cost of outpatient physical therapy and occupational therapy. You pay the remaining 20 percent coinsurance. The exact amount that you pay may vary depending on whether or not your doctor accepts Medicare assignment. Ask your doctor about your cost options.

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What If I Have Medicare Advantage

While original Medicare doesnt cover massage therapy, some Medicare Advantage plans may.

Medicare Advantage plans are private insurance plans. Theyre approved by Medicare, and they cover everything original Medicare does. However, these plans often extend coverage to other areas of treatment, including vision and dental care.

As of 2019, therapeutic massage is covered as a supplemental benefit under some Medicare Advantage plans. According to CMS, about 270 Medicare Advantage plans offer massage coverage, covering nearly 1.5 million enrollees.

For Medicare Advantage to cover massage therapy, youll need to:

  • Seek treatment for a condition thats related to an injury or illness, such as chronic pain or limited mobility.
  • Get an order or prescription from an in-network doctor for massage therapy to treat a covered medical condition.
  • Find a state-licensed massage therapist whos registered with your plans network and has a National Provider Identifier.
  • Your Medicare Advantage plan may not cover 100 percent of the costs of your massage therapy. You may still owe a copayment or deductible.

    Whats more, Medicare Advantage plans with these additional areas of coverage often cost more than more limited plans. However, those higher plan costs may be offset by the costs they cover for additional benefits.

    Implementation Of The Bipartisan Budget Act Of 2018

    This section was last revised in November 2021 to reflect the CY 2022 KX modifier thresholds and to add information from the CY 2022 physician fee schedule final rule on section 53107 of the Bipartisan Budget Act of 2018. On February 9, 2018, the Bipartisan Budget Act of 2018 was signed into law. This law included two provisions related to Medicare payment for outpatient therapy services including physical therapy , speech-language pathology , and occupational therapy services:

    • $2,150 for PT and SLP services combined, and
    • $2,150 for OT services.
    • CQ modifier: PT services furnished in whole or in part by PTAs and
    • CO modifier: OT services furnished in whole or in part by OTAs.

    For CY 2022, in response to stakeholders concerns and to promote appropriate care, CMS revised the de minimis policies and defined 2 exceptions when the de minimis standard is not applied:

    For more information about other outpatient therapy payment policies, please see:

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    What Does That Mean

    We dont really know yet and dont have enough information.

    That specific language is concerning to me do they mean that massage therapy will only be used in home based palliative care situations and not be a part of rehabilitation benefits to reduce pain and help deal with musculoskeletal injuries?

    There is much that we will need to know. Here are some things to start asking:

    • What plans will cover massage therapy?
    • What is the language in each plan that says massage therapy will be covered?
    • Is there a definition of medical necessity in each plan around the massage therapy benefits? What does it say? Will massage need to be medically necessary?
    • Will a prescription be required?
    • What will be covered? Will it cover massage for rehabilitation from surgery, injuries or just the palliative care?
    • Will it cover massage therapy for cancer recovery?
    • What will the benefits be?
    • What CPT code will be allowed? 97124 or 97140 are the two main codes allowed now by health insurance.
    • How many sessions will be covered?
    • How will medicare be billed?
    • Will billing insurance make your massage business more profitable? See the formula for figuring it out.

    The Above Policy Is Based On The Following References:

    Massage Therapy: Does Medicare Cover It?
  • American Academy of Dermatology, Guidelines/Outcomes Committee. Guidelines of care for superficial mycotic infections of the skin: Onychomycosis. J Am Acad Dermatol. 1996 34:116-121.
  • Bending A. Fungal nail infections: Far more than an aesthetic problem. Br J Community Nurs. 2002 7:254-259.
  • Louisiana Medicare Part B. Foot care. Medicare Part B Medical Policy. Baton Rouge, LA: Louisiana Medicare February 2000.
  • Melkus GD, Maillet N, Novak J, et al. Primary care cancer and diabetes complications screening of black women with type 2 diabetes. J Am Acad Nurse Pract. 2002 14:43-48.
  • Neale D, Adams I, eds. Common Foot Disorders. 2nd ed. New York, NY: Churchill Livingstone 1985.
  • OConnor JJ, Deroche CB, Wipke-Tevis DD, et al. Foot care self-management in non-diabetic older adults: A pilot controlled trial. West J Nurs Res. 2020 193945920962712.
  • Reiber GE, Smith DG, Wallace C, et al. Effect of therapeutic footwear on foot reulceration in patients with diabetes: A randomized controlled trial. JAMA. 2002 287:2552-2558.
  • U.S. Department of Health and Human Services, Health Care Financing Administration . Foot care and supportive devices for the feet. Medicare Carriers Manual §2323. Baltimore, MD: HCFA 2000.
  • U.S. Department of Health and Human Services, Health Care Financing Administration . Foot care. Medicare Carriers Manual §4120. Baltimore, MD: HCFA 2000.
  • Yale JF. Yales Podiatric Medicine. 3rd ed. Baltimore, MD: Williams & Wilkins 1987.
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    Do You Have Coverage For Massage

    Massage therapy may be defined in several different ways by an insurance company. How it is defined and the reason for getting the massage will determine whether you will be covered by your insurance.3 If a massage therapist treatment isnt covered in your policy, be sure and ask about these alternative options and discuss them with your doctor.

    There is no standard requirement for insurance companies to reimburse expenses for massage. Massage therapy may be covered when:

    • The massage is considered medically necessary and/or fits the definition and criteria of coverage given by the health insurance company.
    • If the massage fits into the criteria of a habilitative or habilitation treatment, it may be covered by health insurance as an essential health benefit. You would have to speak with your doctor and your insurance company to be sure.

    More health insurance companies are starting to cover massage therapy, so the first thing you need to do to find out if its covered in your situation is to ask your insurance company directly.

    Massage Therapy And Healthcare Policy

    CMS encourages Medicare Advantage plan providers to include massage therapy coverage for pain management. Some alternative therapies are considered a safer substitute for opioids and other addictive substances prescribed to patients suffering from chronic conditions or injuries.

    According to CMS, 270 plans are now offering therapeutic massage therapy, along with other supplemental benefits like adult day care, caregiver support, and home-based palliative care. In 2019, 1.5 million Medicare beneficiaries were able to take advantage of these new benefits.

    CMS has stated that it plans to expand coverage into new types of benefits in 2020 and beyond, which is good news if youre interested in massage therapy options under Original Medicare.

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    Ways To Get Help Paying For A Massage

    There are ways to save on getting a massage. Here are some of the top choices.

  • See if you can use HSA, FSA, or MSA funds towards your massage.
  • Look up Groupons, Living Social coupons, or other coupons for massages in your area.
  • Join a massage therapy spa to get discounts on treatments.
  • Get a massage at a massage training institute, where you can have a session with a student for as little as $20.00.
  • Put aside money each month in an account just for self-care activities for you.
  • Trade services you can do with a massage from a therapist you know.
  • Use a foam roller or massage ball at home to massage your muscles. You can find videos online that will offer you good massage tips with a foam roller or massage ball.
  • What Is The Best Treatment For Toenail Fungus

    Is restorative/recovery massage a covered service billable to Medicare?

    Toenail fungus may seem like a minor issue to some, but those who experience it know the difficulties that come along with the condition. For both aesthetic and health-related reasons, the prevention and treatment of toenail fungus should be a top priority. If your toenail fungus keeps coming back, Dr. Hochstein at Great Neck Family Footcare has the experience to provide you with the treatment you need today!

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    With Massage Therapy Coverage Cost

    Like all benefits, the more coverage a policy offers, the more it usually costs. The cost will vary by insurer. Taking health insurance through an employer can save you money because the employer will often pay part of the cost of the premium for you, and may also offer health insurance plans with more benefits, like massage therapy. If the massage is considered rehabilitative or is medically necessary, then insurance will not cost you more, as this may fall under the coverage of the Affordable Care Acts 10 essential health benefits.

    How Do You Know If You Have Toenail Fungus

    Your best bet is to get your toenails looked at by your trusty podiatrist. If you see any of the signs weve mentioned, just make an appointment for an evaluation. Since the infection will usually spread, youre better safe than sorry.

    Detecting it early also improves the chances for the treatment to do its thing and keep it from moving onto other nails or your skin.

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    Massage Therapy And Hsas

    If you have a health savings account , you may be able to use those funds to pay for massage therapy. To count as a qualified expense, the massage therapy must be deemed as medically necessary. Generally, a letter from your doctor will suffice to prove such services as a medical necessity.

    Although Medicare currently doesnt cover most massage therapy services, that could change as its role evolves as an accepted medical treatment.

    The good news is that even if your Medicare Advantage plan doesnt offer massage therapy benefits, you may still be able to get affordable treatment. If you have a local massage school nearby, you may get massage therapy at a steep discount. Many massage therapy practices also offer membership options that lower the cost of individual sessions.

    If you do have massage therapy benefits with your Medicare coverage, be sure that you fully understand the specific benefits available to you before you book a massage. That way, youll avoid any unpleasant surprises at billing time.

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    Cpt Codes For Massage Therapy

    Does Medicare Cover Massage?

    Once youâve verified that massage therapy coverage is possible, the two main billing CPT codes identified for insurance billing of massage therapy include:

    • 97124: Stroking, compression, percussion
    • 97140: Manipulation, traction, lymphatic drainage

    Code 97124 is more so directed at massage therapy, while 97140 is actually for manual therapy. When billing for either of these two codes, be sure to cite these exact treatment procedures in your claim to ensure coverage. Additionally, do not cite both of these codes when submitting for reimbursement. Insurance companies will not cover services if both of these codes are cited.

    Be sure to also have your clientâs insurance information & photocopies of their card on file, as well as their chart notes for each session readily available. These will be essential when filling out your CMS-1500 forms for each reimbursement.

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