Vol. 15 Issue 21
Using Massage Therapists Under Medicare
By Pauline Watts, MCSP, PT, and Danna D. Mullins, MHS, PT
Question: Is it acceptable to use massage therapists in treatment of Medicare (Part B) patients, specifically charging 97140 ("Myofascial Release as Part of Manual Therapy" charge) performed by a massage therapist under the direct supervision of the physical therapist? I know this is going on a lot in our area, and I think we could all use some clarification on the guidelines. This seems like a stretch of the rules to me.
Answer: Under Medicare regulations, only licensed physical therapists and physical therapist assistants are allowed to provide and bill Medicare for physical therapy services under Part B.
The use of an aide (which is what the massage therapist is in Medicare's view) is not allowed for direct one-on-one care procedures under Part B. Medicare does not recognize a licensed massage therapist as a provider of therapy services for reimbursement.
The regulations governing Medicare can be found in the Code of Federal Regulations Title 42, Public Health at www.access.gpo.gov/nara/cfr/cfr-table-search.html.#page1.
Medicare does allow the use of supportive personnel and qualifies their use under Standard: Supportive personnel, Conditions of Participation section 485.713.
"If personnel are available to assist qualified physical therapists by performing services incident to physical therapy that do not require professional knowledge and skill, these personnel are instructed in appropriate patient care services by qualified physical therapists who retain responsibility for the treatment prescribed by the attending physician."
Another factor that comes into play is your state practice act.
Many practice acts state that a physical therapist shall not delegate portions of the skilled physical therapy functions or tasks to any lesser trained health personnel than the physical therapist assistant. Myofascial release certainly falls into this category.
Question: Can anyone clearly define what Medicare determines to qualify as a new evaluation and a reevaluation? I have heard there is a time parameter of a three-year wait between "evaluations." What is the anatomical delineation between body parts that allows an examination to be considered a new evaluation? If Mrs. Jones is evaluated for the cervical spine with right radiculopathy in January 2003, is discharged in March 2003 and returns in October 2003 with a possible partial rotator cuff tear on the left, would the October visit be considered a new evaluation?
Answer: Medicare has never placed a limitation on how long someone has to wait between evaluation/treatments or delineation of body parts treated.
Medicare requires that when a person is started on treatment, the start of care date remains the same until the beneficiary is discharged from therapy, even if the beneficiary undergoes a new diagnosis requiring a re-evaluation.
A re-evaluation is required when there is a significant change in the patient's level of functioning (e.g., the patient has suffered a new injury or illness that will impact the current plan of treatment).
Medicare does not expect a patient to be "discharged" just because some new injury or illness has occurred. Instead, generate a new plan of treatment but continue on in the "same episode of care" until the patient no longer requires therapy services.
There can be two or more diagnoses throughout an episode of care. When a patient has achieved his goals and is discharged from services, that episode of care is completed.
If the same patient experiences a new illness after discharge, then a new evaluation would be performed and a new episode of care established.
Re-evaluation should never be confused with the Part B re-certification process. Re-certification is a part of the cost of doing business, and should never be charged as re-evaluation.
If you have a question about Medicare reimbursement you would like the authors to address, send your question and contact information to Medicare Advisor, c/o Linda Jones, ADVANCE for PTs & PTAs, 2900 Horizon Dr., King of Prussia, PA 19406; fax 610-278-1425; email@example.com
Pauline Watts and Danna Mullins are the principal lecturers for Encompass Consulting and Education LLC, a rehabilitation consulting and education company in Tamarac, FL. You may contact the authors at firstname.lastname@example.org