Blue Cross of Minnesota will no longer pay for Manual Therapy

October 16, 2008

Blue Cross of Minnesota will no longer pay for Manual Therapy

Over the past week, private practice PT owners have been receiving this provider bulletin (P22-08) Download post71a_125818.pdf in their mailboxes. Briefly it states:

Massage and manual therapy exclusion
Effective January 1, 2009, Blue Cross and Blue Shield of Minnesota and Blue Plus will no longer reimburse providers for massage or manual therapy services. Massage or manual therapy will deny either as incidental (provider liability) or subscriber liability.

Massages that are provided as preparation for a chiropractic manipulation or other physical medicine therapies, are considered an integral part of the chiropractic manipulation or other therapy. As such, we will deny it as provider liability. If a massage is billed alone, then it will be denied as a subscriber contract exclusion.

Codes
97124 Therapeutic procedure, one or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion).
97140 Manual therapy techniques (eg, mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes.

Liability
Provider liable:
Massage and manual therapy (97124 and 97140) will be denied incidental (provider liable) to chiropractic manipulations or other physical medicine procedures billed on the same date of service. The denial will be upheld regardless of submission of the -59 modifier. Additionally, submission of the -GA modifier will not affect or change the denial.

I found out about this Monday night and quite honestly said, What the Hey!! and immediately fired off emails to MN APTA, APTA, EIM team, friends, co-workers, etc. Others have done so as well.

As of this morning, a unified effort is taking place. The MN chapter of the APTA is trying to get some answers from BC of MN and determine when and with whom we can meet to discuss. At present, Blue Cross of MN is not being very helpful. Nationally, the APTA is aware of the issue and waiting to help if the matter can't be resolved by the MN Chapter and PT providers in a timely manner.

In Minnesota, lots of theories are circulating as to exactly why and what Blue Cross was trying to do here. From a research perspective, the recent September JOSPT Neck Guidelines and articles like the one by Walker et al. that came out in Spine today make supporting the efficacy of manual therapy and it's use with exercise a slam dunk.