Vivian M. Mahoney, LMT
FSMTA Insurance Consultant
January 15, 2010

Phone: 865-436-3573
Email: vivianmadison [at] aol [dot] com
Website: MassageInsuranceBilling.com

PRESCRIPTIONS, CODING, DIAGNOSING & FEES

FL LMT NOTICE REGARDING PRESCRIPTIONS:
I am often asked what is legally required to be on a prescription in order for a FL LMT to be able to bill insurance for a physician’s referred patient.

WHAT THE LAW SAYS:
FL Law enacted October 2nd 1992 states that a prescription must indicate: Duration, Frequency and Diagnoses. It also states which physicians can refer. This law stated MD’s, DO’s, DC’s & Podiatrists

However the new FL PIP law for auto accident cases now eliminates Podiatrists and includes Dentists.

Also necessary is referring Physician’s Name and NPI #

ABOUT PROCEDURES & MODALITIES:
From my many years of experience I find that in order to avoid delays, reductions and denials from insurance companies it is also important for the physician to indicate the procedure and modality we are to use.

Because the majority of physicians are not familiar with the type of training we have had (nor should they have to be concerned with that) it is important that the service we provide is indicated on the prescription.

Thus the reason I created a “prescription” in 1985 with all that’s needed. The therapist should indicate the procedure(s) and /or modality(s) by checking those they normally or most often provide and wish to be reimbursed for by insurers.

Since most LMT’s provide more than basic Swedish massage & are trained in deep tissue, neuromuscular therapy and myofascial release techniques, this must be indicated on prescription in order to be paid for it.

If a prescription states only “Massage” then only 97124 “massage” can be billed. If the LMT has not had training in other procedures or modalities and if a procedure is not in your scope of practice DO NOT BILL IT.

Therefore use the prescription in my manual (CD in back of manual) and check mark the modalities and procedures you personally use. Mark an X by Manual Therapy Techniques, X Hot /Cold Packs and X Initial Evaluation or write it in Other ___________ OR X CPT Code 97799.  Do not over do but if you use other modalities often you may wish to X that modality such as Ultrasound, Electrical Stimulation & Hydrotherapy.

This way it eliminates time and decision making for the physician and helps you to be successfully paid.

PRESCRIPTION EXPIRATION:
Be sure you are aware at all times of prescription deadlines and have them renewed prior to continued treatment and billing.

ABOUT DIAGNOSING
Be 100% sure you NEVER indicate a diagnoses on this prescription as diagnosing is strictly outside our scope of practice.

MORE ABOUT PROCEDURES & MODALITIES:
If you do not have the training, if it is not in your scope of practice and even if it is, and if you cannot comfortably explain in a court of law before a judge and jury, before an insurance company’s defense attorney, then DO NOT USE or BILL IT.

FEE FOR SERVICES:
The exact same thing applies here as above for procedures and modalities. It does not matter what the law says you can bill, be comfortable emotionally, mentally and legally with your fees. Know and understand negative ramifications of over charging as well as over coding and over billing.

Any questions, contact me at: 865-436-3573

Vivian M. Mahoney, LMT (25 Years)
FSMTA Insurance Consultant (18 years)

Click here to download Vivian’s previous update with more information about insurance billing .

If you can’t find the answers to your questions here, please feel free to contact Vivian directly.  She is the expert when it comes to billing insurance for massage therapy!