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Insurance Billing News

24 Apr 2012 1:28 PM | Anonymous member (Administrator)
If you bill insurance, you need to be aware that in Oregon, you can no longer bill for CPT codes that reflect specific other licensed practices.  For example, code 97001: PT Evaluation.  This code implies that you are a licensed Physical Therapist (if you hold dual licensure, you can bill under your PT license).  The repercussions can be relatively minimal (insurance companies refusing to pay for services under that billing code) to more drastic (potential investigation/penalties) for practicing outside of scope.

This is a frustrating issue for many LMTs, but after discussion with a PT professional association, the PT Board, and the AMA CPT panel massage therapy representative, it was determined that this code is not appropriate for massage therapists to use.  The CPT panel is looking at alternatives for massage therapists to bill for evaluations, but it is a slow process and there is nothing concrete to report on the status of potential changes at this time.

If you have successfully billed for this code in the past, please know that insurance companies may begin denying billing under these codes.  LMTs are currently expected to bill the same as for treatment time (i.e., 97124).

Any LMT billing insurance needs to ensure that they are doing so legally and ethically.  Please be aware that this is your responsibility to know this information and stay current with it, and it may vary from what you were taught in an insurance billing class.

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