Have you ever filed an insurance claim for a physical therapy massage? It sounds as simple as the massage itself, but in reality, it is very tricky and confusing even for experienced billers. CPT code 97124 is a code that all physical therapy billers know, both because it is used frequently and because it is also one of the most denied.
That is why we created this detailed guide on CPT 97124. We will explain what this code covers and how you can use it correctly in your claims. So, let’s start.
CPT Code 97124 – Description
CPT code 97124 is defined as:
“Therapeutic procedure, one or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion).”
That’s the official definition, but it is hard to understand, so let’s simplify it.
97124 is used to bill a massage technique. This massage is not what you get in massage centers; rather, it is delivered by qualified healthcare professionals. Massage therapists use this to relieve pain, reduce muscle tension, and improve blood circulation in the tissue. So, it can only be performed when a clear therapeutic goal is to be achieved.
The definition mentions three terms: effleurage, petrissage, and tapotement. Here’s what they mean:
- Effleurage: Long, gliding strokes used to warm the tissue, promote relaxation, and stimulate blood flow.
- Petrissage: Kneading, lifting, and squeezing of muscle tissue to relieve tightness and soft tissue restriction.
- Tapotement: Rhythmic tapping or percussion used to stimulate muscle response and circulation.
The important point to note from the definition is that CPT code 97124 is billed per session. Each session lasts 15 minutes. So, we can deduce that it is a time-based code.
Now, an important point to mention here is that many billers get confused between 97124 and CPT code 97140 (manual therapy). Both codes are similar in nature, but their scope of service is different. As we have explained, 97124 is limited to massage techniques. On the other hand, 97140 has a much larger span of therapy services. This includes techniques like joint mobilization, manual traction, and myofascial release. Hence, as per the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edits, these codes cannot be billed together on the same service date.
Scenarios Where CPT Code 97124 is Applicable
Let’s look at a couple of real-world scenarios in which CPT code 97124 can be used:
Scenario 1
Suppose a man works as a laborer in a warehouse. One day, he was lifting a heavy box, which resulted in an injury. He goes to a physical therapist after the pain continues for weeks. The patient tells the therapist that he has persistent lower back tightness, muscle guarding, and lumbar paraspinal spasm that limit bending. The patient also tells the therapist that he has tried some stretching on his own, but it didn’t help.
After examining the patient and hearing the background, the therapist suggests active exercise. However, before the exercise, he needs to reduce the muscle guarding and improve the mobility of soft tissues. To do this, the therapist performs 15 minutes of therapeutic massage using effleurage and petrissage.
In this case, the billing department can use one unit of CPT code 97124 to bill the massage session.
Scenario 2
Let’s look at another scenario. Suppose a patient is several weeks post rotator cuff repair surgery and is receiving physical therapy under the surgeon’s postoperative protocol. The incision is fully closed and medically cleared for appropriate soft-tissue treatment. The patient has postoperative shoulder stiffness and guarding involving the surrounding musculature.
After confirming that no restriction prohibits the intervention, the physical therapist performs 15 minutes of gentle therapeutic massage to appropriate surrounding soft tissues, avoiding excessive pressure over the repair and incision. The massage is intended to reduce pain and guarding before protected therapeutic exercise.
If medically necessary, properly documented, and covered by the payer, the service may be reported as one unit of CPT code 97124.
Applicable Modifiers for CPT Code 97124
The following modifiers are frequently used with CPT code 97124:
| Modifier | Description | When to Use |
|---|---|---|
| 59 | Distinct Procedural Service | Append when 97124 is billed alongside another therapy code that is not 97140, to show the services were separate, medically necessary interventions. |
| GP | Services Delivered Under an Outpatient Physical Therapy Plan of Care | It is used to indicate that the massage was furnished under a physical therapist’s plan of care. |
| CQ | Services Furnished in Whole or in Part by a Physical Therapist Assistant (PTA) | Append when a PTA performs the massage under the supervision of the physical therapist. |
CPT Code 97124 – Reimbursement Guidelines
The following are some essential billing guidelines that you must know before filing claims for CPT 97124:
Check the Coverage Status First
Many billers think that since 97124 has a fixed reimbursement amount on the Medicare Physician Fee Schedule, it is automatically reimbursable. This is not true. Medicare generally treats massage therapies as an excluded service because of their classification under routine wellness treatment. Hence, most Medicare Administrative Contractors (MACs) deny 97124 outright regardless of documentation.
However, some commercial payers do reimburse 97124. So, before submitting the claim, always check with the payer about their reimbursement policy.
Provide Detailed Documentation
Comprehensive documentation is your best defense against denials and audits. The treatment note for each session billed under CPT code 97124 should include:
- Medical Necessity: The diagnosed condition driving the need for massage, such as muscle spasm, soft tissue adhesion, or restricted mobility.
- Start and Stop Times: Exact treatment minutes to support the unit count billed.
- Technique Used: Effleurage, petrissage, tapotement, or a combination, along with the body area treated.
- Patient Response: Functional change or symptom relief observed after the session, linked back to the plan of care.
Wrapping Up
Finally, we have reached the end of this guide. But before wrapping up, let’s quickly recap some of the essential points that we discussed in the guide.
- CPT code 97124 is used to bill therapeutic massage.
- It is billed in 15-minute sessions, so you need to track time accurately.
- Medicare generally does not reimburse this, but other payers do. So, check coverage before performing the service and filing the claim.
If you are new to physical therapy billing or your practice is getting frequent denials for massage therapy, we suggest getting help from professionals. Many billing companies like NeuraBill offer premium physical therapy billing services that you can rely on.
