CPT-97124

“Therapeutic procedure, 1 or more areas, each 15 minutes massage, including effleurage, petrissage, and/or tapotement (stroking, compression, percussion)”

Code Type

Timed-Based Code

Add-On Code

No add-on code

CPT 97124 should be used when a qualified healthcare professional performs any massage technique on the patient in a clinical setting. The qualified healthcare professional includes:

Physical Therapist
Occupational Therapist
Chiropractors
Physical Therapist Assistant
Occupational Therapy Assistant
Massage Therapist
Physician

Note: CPT 97124 should not be used to bill myofascial release.

Types Of Massage Therapy Techniques Included Cpt 97124.

Massage Therapy may include any of the following Swedish massage techniques:

Effleurage
Tapotement
Petrissage
Deep friction massage

1. EFFLEURAGE (Stroking)
Effleurage is a commonly used massage technique in which gentle pressure is used to stimulate muscle relaxation and increase blood circulation to the muscles. It is generally used to prepare the muscles before a more rigorous massage technique . It also increases lymph flow. It can be performed on many body parts using fingers and flat hands in an upward direction towards lymph nodes distributed throughout the body which causes drainage of lymph towards lymph nodes. The Effleurage Massage technique can be used in many circumstances. Some of them are:

To promote muscle relaxation
To reduce stress on stiff joints due to muscles tightness
Post-injury and post-surgery to diminish muscle guarding

2. TAPOTEMENT (Percussion)
“Transfer of repetitive rhythmic and rapid pulses and vibrations to the soft tissues”. Soft blows using cupped hand, tips of the fingers ,edge of the hand over the fleshy part of the body (e.g. Gluteus Maximus), particularly avoiding areas of bony prominence as it can cause discomfort to the patient.
Benefits:

Stimulation of skin and muscle reflexes.
Increased circulation to the stressed muscle, resulting in flushing out of toxins.

3. PETRISSAGE (Compression)
Involves kneading, squeezing, and stretching of the taught muscle. Deep pressure is applied over the tight muscle to release muscle knots and spasms.
Benefits:

Loosen muscle fibers and stretch the tight muscle
Increase circulation to the muscle, resulting in flushing out of toxins
Reduce DOMS (Delayed onset of muscle soreness)
Break down soft tissue adhesions after muscle injury or surgery

4. DEEP FRICTION MASSAGE
Deep pressure is applied to the underlying muscle with a ball of the thumb or fingers to produce shear force between different types of underlying tissues (such as fascia and muscle).
Goal:
The purpose of this massage technique is to prevent or mobilize soft tissue adhesions due to scar formation which leads to decreased ROM.

CODING GUIDELINES

One-on-one therapy code
Billed in 15-minutes increment
Require a therapy modifier (GP, GN, GO, CO, CQ)
CMS 8-minute and AMA rule of Eights are applied

CMS 8-Minute Rule:

A minimum of 8 minutes of direct contact with the patient must be provided for a single unit of 97124 to be billed.

Units	Number of Minutes
1 unit	≥ 08 minutes through 22 minutes
2 units	≥ 23 minutes through 37 minutes
3 units	≥ 38 minutes through 52 minutes
4 units	≥ 53 minutes through 67 minutes
5 units	≥ 68 minutes through 82 minutes
6 units	≥ 83 minutes through 97 minutes
7 units	≥ 98 minutes through 112 minutes
8 units	≥ 113 minutes through 127 minutes

The pattern remains the same for treatment times of more than 2 hours .

AMA Rule of Eights:

“AMA guidelines state that incremental intervals of treatment performed on the same session may be added together when determining total time in direct contact of a qualified healthcare provider with the patient is necessary. Each unique timed service is counted separately instead of combining the time from multiple units” .

Physical Therapy Modifiers

Below mentioned modifiers are used when services are provided for the respective plan of care:

MODIFIERS	PLAN OF CARE
GP	Outpatient Physical Therapy
GO	Outpatient Occupational Therapy
GN	Outpatient Speech-Language Pathology
CQ	Outpatient Physical Therapy by a Physical Therapist Assistant (completely or partially)
CO	Outpatient Occupational Therapy by an Occupational Therapy Assistant (completely or partially)

TOTAL NO. OF BILLABLE UNITS

04 units are allowed per date of service by CMS but more can be billed if justified by medical notes.

MEDICAL NECESSITY

It may be considered medically necessary if one of the following conditions is present and documented:

Muscle contracture and decreased ROM
For relaxing the muscle before neuromuscular re-education or therapeutic exercise or stretching
Tight muscles result in spasticity and shortening of the muscle
Soft tissue adhesions
Muscle paralysis resulting in impaired circulation
Mobilization of Interstitial fluid to improve lymph drainage or reduce edema

REIMBURSEMENT GUIDELINES

For reimbursement of these CPTs following elements must be documented in the Physical Therapy Notes:

Documentation of medical condition that justifies the medical necessity of massage therapy
Total direct time spent by the provider with the patient
To meet coverage criteria, therapy services have these requirements in common:

Patient condition has the potential to improve
Documentation of improvement from therapy using objective assessment tools and measurements and functional accomplishments
Therapy is not being provided to treat loss of function in conditions that are transient and expected to resolve spontaneously reversible
In the case of maintenance therapy, therapy services cannot be carried out safely by the patient himself or the patient’s family or caregiver and require treatment by the therapist to prevent further deterioration of the patient’s condition
Therapy plan is developed by a qualified/certified healthcare professional

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CPT-97124

Category

Code Type

Add-On Code

Types Of Massage Therapy Techniques Included Cpt 97124.

CODING GUIDELINES

CMS 8-Minute Rule:

AMA Rule of Eights:

Physical Therapy Modifiers

TOTAL NO. OF BILLABLE UNITS

MEDICAL NECESSITY

REIMBURSEMENT GUIDELINES

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