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In Medical Billing, there are two simple things we must remember:

(1) There are millions of health insurance contracts in the US. There is the contract between the patient and the insurance company and there is the contract between the provider and the insurance company.

(2) Each contract is different and has certain restrictions and limitations.

Now, there are federal rules, state rules and each carrier has its own rules. To know all of them would take a lifetime. However, there are some basic rules that apply to all.

If you are not an employee of the provider, you are an independant contractor.

As an independant contractor, if you do not have a contract with the carrier, the patient must be referred to you by the provider and there are restrictions. The service must be medically necessary. It must be approved by the carrier prior to rendering the service, and it must be a covered service. Even then there is no guarantee the claim will be paid.

This is what I found regarding CPT 97142 from the American Chiropractic Association:

The ACA has fielded numerous calls concerning insurance company denials of CPT code 97124, Massage, when billed the same day as a Chiropractic Manipulative Treatment (CMT) code, 98940-98942. An example of the reason given for this denial is that massage is a part of CMT.

CPT 97124 describes the work inherent in massage, which is a separate and distinct service from CMT codes 98940-98943. CPT 97124 describes work including effleurage, petrissage and/or tapotement (stroking, compression, percussion), each 15 minutes.

Massage (CPT 97124) describes a service that is separate and distinct than those services described by Chiropractic Manipulative Treatment, Osteopathic Manipulative Treatment, and Manual Therapy Techniques. Massage, unlike those techniques, is totally passive in nature. The patient did not participate in the procedure and the various massage techniques are applied to the patient.

Massage is applied to a large area often crossing over several types of soft tissue and several areas of soft tissue, and is used primarily for it's restorative effects. In some cases massage may be used for stimulating soft tissue (tapotement).

The expected outcomes of massage are also more general in nature and may, in fact, be what the patient can tolerate at the more acute stage of their treatment plans. This would include such goals as increasing circulation, decreasing muscle soreness, and decreasing muscle spasm. The research available on massage techniques and their impact on the recovery of muscle function following exercise as well as on anyone of the physiological factors related to the recovery process shows that these techniques have very little impact. Its greatest impact is on the broad factors mentioned above in terms of pain modulation, muscle tightness, and blood flow to the related tissues.