06/25/08
There seem to be many questions and anxieties around chiropractors and massage therapist, let me try in this email to clarify potential confusion.

Massage therapy is covered when performed directly by a Chiropractor (DC), MD, DO or PT within an active course of treatment, subject to the member's contractual benefits and limitations.

There are a very limited amount of employer groups that cover services rendered by a massage therapist.

The employer groups that today recognize services performed directly by a massage therapist (my disclaimer - this list could change at any time), include the following. The benefit visit and dollar amounts could differ by group.

Bowdoin College
City of Portland
Olympia Sports
Maine Health, includes:
Visiting Nurse Services of Southern Maine
Lincoln County Shared Services
Maine Medical Center
Miles Memorial Hospital
Miles Health Care
Miles Medical Group
Cove's Edge Nursing
Nordx
Maine Medical partners
Spring Harbor Counseling
Spring Harbor Hospital
St. Andrews Hospital
Western Maine Health Care (WMHC)
Market Square - affiliate of WMHC
Stephens Memorial Hospital
Western Maine MultiMed
When an employer group covers services performed directly by a massage therapist, the massage therapist should complete an application request form, which is found on the Anthem.com website. This way they will set them up in our claims and provider systems as a recognized professional when the employer group has this benefit.

The services rendered by a massage therapist should not be billed under other provider's NPI numbers.

When a massage therapist is billing Anthem directly for massage therapy services that they are physically performing, they should bill their own NPI individual number in box 24J and 33 of the CMS1500 claim form. The massage therapy service would be billed this way whether the massage therapist is practicing as a solo practitioner or working for a provider group. As previously mentioned, the massage therapist must complete the application request form so that they are appropriately set up in our provider files.

When the chiropractor is physically rendering massage therapy services, they should bill with their NPI # in box 24J and 33 of the CMS 1500 claim form. A Chiropractor (or any other provider) should not be billing services for massage therapy when physically rendered by a massage therapist.
All providers are expected to only render services that are within the scope of their practice and ensure that documentation in medical records reflect the service rendered consistent with the procedure code billed.

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