Manual Therapy vs Massage: What’s the Difference?

March 26, 2018
Rick Gawenda

I often receive the following questions regarding massage and manual therapy:

  • What is the description of massage and manual therapy?
  • Does the Medicare program pay for massage and manual therapy?
  • What is the difference between massage and manual therapy?
  • What is the difference in payment between massage and manual therapy?
  • Do private insurance carriers pay for massage (CPT Code 97124)

In this article, I will answer the above 5 questions.

According to the American Medical Association (AMA), CPT 2018 Professional Edition, the descriptions for massage and manual therapy are as follows:

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  1. Thanks for the definition clarifications. I thought LDT was a massage technique and that massage was not as limited in techniques as you have defined. Good info. Any idea why manual therapy, which requires more complicated training (arthrokinematics, etc) and more sophisticated techniques is reimbursed less than the simpler massage techniques?

    1. Manual lymphatic drainage techniques has always been manual therapy. Massage saw a significant increase in its practice expense relative value unit in 2018 and this is the main reason that massage now pays a higher rate than manual therapy in 2018 under the Medicare Physician Fee Schedule.

  2. If we start having the therapist bill massage (when they do it on a swollen knee to say) – won’t it be a red flag to Medicare since in the past we have always only billed manual therapy? Of course, documentation would have to support what they bill.

    1. You need to bill for the services that you provided and are supported by the medical record documentation.

  3. Medicare/insurance companies need to explain this better when subscribers call. It confuses the patient. Patients think that massage therapy provided by massage therapists come under this code. They don’t explain that the procedure needs to be performed by PT.

  4. If a Therapist does perform both on the same day and we know that we will only get reimbursed for Manual Therapy, must we still bill for the Massage? Since this is a NCCI edit, is it wrong to bill it if indeed the services were performed as distinct separate services and you know you will not be reimbursed?

    1. CMS does not address if it is wrong or not wrong to bill. CMS has just determined they will not pay for CPT code 97124 when billed on the same day as CPT code 97140, even if you attach modifier 59 to CPT code 97124 on the claim form.

  5. Does manual lymphatic drainage need to be performed by a certified specialist in order to bill for manual therapy or can a physical therapist be trained in lymphatic drainage to be able to bill for this type of treatment legally?

    1. I do not answer from a legal perspective as I’m not an attorney. I’m not aware that any insurance carrier requires a therapist to be certified in MLD.

  6. One question that is never answered….what is the specific difference, according to Medicare, of when to bill massage or manual for STM. Any kind of massage is in fact a type of soft tissue mobilization, no?

    1. The Medicare program does not and will not define when to bill massage or manual therapy for soft tissue mobilization. That will be for the therapist to determine based on technique(s) provided and documentation in the medical record.

  7. Does Medicare only reimburse for Massage Therapy if it is a component of a physical/occupational therapy plan of care?

  8. Should PROM be documented as Therapeutic exercise or can it be documented under Manual Therapy – or does it depend on what you are doing/how you are documenting. Does insurance coverage matter? We have heard conflicting info on this.

    Thank you.

  9. Can a physical therapist assigned soft tissue mobilization, trigger point release, myofascial release to a massage therapist, monitor treatment before and after and bill the service as manual therapy 97140?

    1. You will need to check your respective state practice act on who you can delegate services to and what services can they provide. You then also need to check with the insurance carrier to see what they allow.