02.19.2009

What is the average price to charge the insurance company for a massage?

Mrs. Browne asked:


I am just starting to do insurance billing for my massage clients. I want to know what the average price other therapists charge to the insurance company.

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Posted under Insurance

3 Responses to “What is the average price to charge the insurance company for a massage?”

  1. bud68 Says:

    You can charge whatever you want. The insurers will only pay the benefit already established in their system.

  2. sarah314 Says:

    It doesn’t really matter what you charge.

    You will only get paid based on what the insurer determines to be the “usual and customary rate” for your services. (Or, if you have signed a contract with the insurance company, you’ll get paid based on your negotiated rate.)

    Obviously that’s assuming that you get paid anything at all. The vast majority of benefit plans exclude coverage for the services of a massage therapist. (I happen to have coverage for up to $500 worth of massage therapy w/a doctors prescription per year, but that is an extremely rare benefit.)

    For the rare client of yours who would get some sort of reimbursement, the charge for your service has very little to do with what you’ll actually get paid. The insurer will allow what they determine to be the usual and customary rate, and that’s all you’ll get. You will either have to write off the balance, or bill the patient for the balance (if allowed).

  3. Scooch Says:

    97124 - Massage Therapy $25 per 15 minute unit
    97140 - Manual Therapy (Including Myofascial Release) $35 per 15 minute unit

    These will vary depending on locations, but this is a good average.

    These are the most basic codes to use as a massage therapist, but only bill one or the other during a single session, not both. Make sure you differentiate between the two and have explanations ready as to how they differ. This will help when insurance reps & attorneys start asking questions.

    Also set out separate fee structures for Clients and Patients. If you have not already, do yourself a favor and seek out a published manual on how to start in insurance billing because there are some laws to adhere to that can ruin your career if you do not follow them. The two I recommend are found at these websites. Best wishes on jumping into a new playing field…

    Here is another site with some good info.