What Is CPT Code 97124 for Massage Therapy?

Current Procedural Terminology (CPT) codes serve as a standardized language for healthcare providers to describe medical services and procedures for billing and reporting purposes. Understanding specific CPT codes is important for patients seeking to comprehend their medical bills and insurance coverage. This article specifically explains CPT code 97124, which is used for therapeutic massage.

Understanding CPT Code 97124

CPT code 97124 is defined as “Therapeutic procedure, one or more areas, each 15 minutes; massage, including effleurage, petrissage, and/or tapotement (stroking, kneading, tapping).” This code is designated for therapeutic massage therapy services, meaning it is applied when massage is performed as a treatment to improve physical function, rather than for general relaxation. The phrase “one or more areas” indicates that the therapeutic massage can be applied to different body parts during a single session, addressing multiple affected regions as needed.

The “each 15 minutes” aspect signifies that this is a time-based code, where the duration of the therapy directly influences the number of billable units. For example, a session lasting 25 minutes might be billed as two units, as at least eight minutes of therapy must be provided to bill a single 15-minute unit. The code specifically mentions three core massage techniques: effleurage, petrissage, and tapotement. Effleurage involves smooth, gliding strokes, often used to warm up muscles, promote relaxation, and increase blood flow at the beginning or end of a session. Petrissage consists of kneading, lifting, and squeezing motions, targeting deeper muscle layers to release tension, improve circulation, and enhance flexibility. Tapotement is a rhythmic tapping or percussive motion, which can stimulate muscles and nerve endings. These techniques are applied manually by a licensed healthcare provider to achieve specific clinical outcomes related to soft tissue function.

When Code 97124 is Applied

Healthcare providers typically apply CPT code 97124 when therapeutic massage is considered medically necessary as part of a comprehensive treatment plan. Conditions that may warrant the use of this code include muscle pain, stiffness, limited range of motion, or soft tissue adhesions, often following an injury or as part of rehabilitation. For instance, it might be used to restore muscle function, decrease specific stiffness, reduce documented edema, or relieve muscle spasms. The treatment plan should outline specific deficits and goals, with expected outcomes and objective measures to evaluate the effectiveness of the treatment.

This code is commonly utilized by licensed professionals, including physical therapists, occupational therapists, and chiropractors, among others. These providers integrate therapeutic massage into a broader rehabilitation strategy to restore function, reduce pain, and enhance overall treatment outcomes. It is important to understand that CPT code 97124 is not used for general wellness or relaxation massages that are not prescribed for a specific medical condition.

Billing Considerations for Code 97124

Billing for CPT code 97124 relies on its time-based nature, meaning the service is billed in 15-minute increments. Providers track the actual time spent in direct contact with the patient performing the therapeutic massage. For example, a session lasting 23-37 minutes would typically be billed as two units, while 38-52 minutes would constitute three units.

A primary consideration for insurance coverage is medical necessity. Without clear evidence of medical necessity, insurance companies may deny coverage, as they generally do not cover services provided solely for relaxation or general wellness.

Proper documentation by the provider is essential to support both the medical necessity and the time spent during the session. This includes detailing the specific body regions treated, the massage techniques applied, and the patient’s response to the treatment. Such thorough records help substantiate the claim and can prevent denials or audits. Patients should always verify their specific insurance benefits and policy coverage for therapeutic massage, as coverage can vary significantly among different insurance plans and providers. Medicare, for instance, has limited coverage for massage therapy and often considers it a covered service only when provided as part of a comprehensive treatment, not as an isolated therapy.