97124 CPT code

97124 CPT code or massage therapy includes therapeutic procedures that apply therapeutic massage over body muscles and tissues to stimulate the circulatory system, relax muscles, and manage soft tissues. It is a timed code and includes massage techniques such as effleurage, tapotement, and petrissage. 

Occupational therapists may use specialized massage techniques to prepare patients for therapy such as massage for a therapeutic effect to decrease muscle tension or manage scarring on the hand/fingers before participation in therapeutic exercises. 

This article will discuss specifics for billing for 97124 CPT code to help you prepare for using this procedure code in your practice.  

Understanding 97124 CPT code

The definition for 97124 CPT code is a therapeutic procedure consisting of massage, effleurage, petrissage, and tapotement (stroking, percussion, or compression) to one or more body areas, every 15 minutes. This is a timed code and intended for use by qualified healthcare providers, including physical and occupational therapists.

Types of procedures covered by 97124 CPT code include effleurage, deep friction massage and tapotement. 

Effleurage uses gentle pressure to stimulate muscle relaxation and circulation to warm up a muscle for a more rigorous massage or procedure such as therapeutic exercise. Additional benefits of effleurage include reducing muscle tightness, reducing stress on joints from muscle tension and to reduce muscle guarding after injury or surgery. 

Deep friction massage is used to manage scar appearance and elasticity. 

Tapotement, also called chest percussion, is when a therapist uses a cupped hand, edge of hand or fingertips to deliver soft blows to the body to stimulate muscle reflexes, and increased circulation. 

Medical necessity and coverage criteria 

Medical necessity is considered if one of the following conditions is documented. 

• Muscle contracture that is limiting range of motion

• Soft tissue adhesions

• If muscle tension or spasticity is limiting optimal participation in daily activities

• Impaired circulation due to muscle paralysis

Start Your Free Trial

Documentation requirements 

• Total direct, start and end time recorded by the provider with the patient and total treatment time for session. 

• Documentation of medical conditions that justifies use of massage therapy intervention (rationale) and good rehab potential to improve with skilled services

• Treatment plans should have specific goals directly related to how technique will improve goals directed at improved functional outcome

• Documentation should be signed and dated by the provider who administered service 

• Document location and type of massage therapy technique used 

• Documented outcome measures using objective assessments and recurrent measurements to demonstrate improvement with intervention

• Quality of progress (poor, fair or good), and how progress is directly related to achieving goals in treatment plan and improved participation

• CMS documentation recommendations listed on their site include: 
  • Documentation must clearly justify massage interventions beyond 6 visits including education provided to patient and family for self-management and remaining needs for continued treatment. 
  • Document patient or caregiver education to self-preform techniques to manage conditions. If continued skilled intervention is required after 6-8 visits, document the reason skilled techniques are still necessary to prevent functional decline after education has been provided. 

97124 CPT code and occupational therapy 

Massage techniques used in occupational therapy include procedures listed above to complement other therapy tasks when working through an active treatment plan. Modalities must be documented and billed as a separate code per modality method. Modality must be medically necessary with necessity documented and not billed for the same treatment time as massage therapy to avoid inconsistency with direct, one-to-one treatment time.

Massage therapy techniques can be beneficial in an occupational treatment plan to manage pain, swelling, and range of motion when performing meaningful tasks. Goals for massage therapy techniques are used to prepare the body for another activity such as restoring range of motion or muscle function to increase participation in meaningful activities for the patient.

Maximizing reimbursement for 97124 CPT code 

• Common reimbursement issues include incorrect billing due to using the wrong procedure code 

• Common billing errors include using an incorrect code or not respecting billing restrictions reported in Centers for Medicare and Medicaid Services (CMS) guidelines

• Another common mistake includes billing massage therapy for manual therapy techniques. To ensure billing accuracy, cite the procedure code definition as defined by CMS or the American Medical Association (AMA) and use terminology in your documentation to justify the use of respective codes 

• The difference between using manual therapy, CPT code 97140, and massage therapy, 97124 CPT code is in the desired outcome of the procedure. When the procedure outcome is more of a therapeutic effect to increase circulation and promote muscle relaxation, use 97124 CPT code. If the desired outcome is to increase active pain-free range of motion, manipulate myofascial tissue and facilitate participation in functional activities then use Manual therapy, CPT code 97140 

• Refer to billing guidelines on the American Medical Association website or the Centers for Medicare and Medicaid Services for more information using these CPT codes in your practice