If, in your health and wellness practice, you offer myofascial release, or if it is perhaps the main thing you are doing, one of the crucial things you will have to know is how to actually bill this service. In case you’ve been working as a health and wellness services provider for a while already, there is no doubt in my mind that you understand just how complicated billing can be, and how you can get denied reimbursement for making the slightest error. So, you want to get things done right and ensure proper reimbursement for myofascial release. Go here to better understand the actual procedure.
Clearly, myofascial release is widely used in manual therapy, as it can be quite effective. It is aimed at relieving musculoskeletal pain by actually targeting the fascia. Massage therapists, chiropractors, and physical therapists use it often in their practices, with the goal of reducing discomfort and improving mobility. So, if you also often perform this procedure, you will undoubtedly have to know the right CPT code to use so as to get the reimbursement.
What CPT Code Is Used for Myofascial Release?
Let us begin with that question, then. What CPT code is used for myofascial release? To cut right to the chase, for this procedure, you have to use the CPT 97140, which entails various manual therapy procedures, including this one. Pretty straightforward so far, isn’t it?
While it may sound simple and straightforward right now, the truth is that things can get quite complicated rather quickly. So, you need to know exactly how to get proper reimbursement, which requires you to know the code, understand how and when to use it, and what kind of evidence to provide in order to get what you need. And, well, that’s what we are going to be discussing next.
Read more about myofascial release therapy here: https://www.spine-health.com/treatment/physical-therapy/myofascial-release-therapy
How to Get Properly Reimbursed?
So, what is it that you should do to get properly reimbursed? Quite a few things. Of course, over time, things may become simpler, as you learn how and when to use everything, but if you’re new to this, chances are that you will get a bit overwhelmed with all of it. We are here to try and make things a bit easier by explaining what you should know.
For starters, proper documentation will be required, serving as evidence for your claim. The key here is for you to document the medical necessity of myofascial release therapy, and that will require you to include some important elements into the patient records. First off, a description of the patient’s chief complaint has to be included, and then medical necessity should be clearly stated to justify the treatment. Furthermore, you should mention the targeted areas, that is, the parts of body where MRF was applied, as well as the total time spent performing the procedure, and notes on how the patient responded to it. As for the total time, you should remember that the CPT 97140 is billed in 15-minute increments.
Moving on, you may also need to use proper modifiers during the process. The -59 modifier, for instance, indicates that the manual therapy is distinct and separate from some other procedures you may have billed. Then, -25 modifier can be used if the MRF is performed in the same session in which you provided the patient with evaluation and management services. Understanding the modifiers is essential, because it will help you use them correctly, and thus avoid denials and get properly reimbursed.
To maximize your reimbursement, you should also review your insurance policy and coverage. First, check if myofascial release is covered at all, then check if pre-authorization is required, and finally review the contract to assess the rates. Naturally, apart from checking the coverage, you should also make sure to use the correct myofascial release cpt code and modifier every time you file a claim, aiming at avoiding denials. Ultimately, remember not to overuse the code without justification, as that can trigger audits and, consequently, denials.
An Easier Way to Do It All
I know that it may all sound just a bit too complicated. And, that’s because it most usually is. But, the good news is that there is an easier way to do it all. Basically, what you have to do is find a company specializing in medical billing and coding support services, and let them ensure that the CPT 97140 is properly and accurately used at all times, and that you are, thus, getting adequately reimbursed.
Finding the right partner should, therefore, be your main goal. Take your time to find and research different companies. Inspect their reputation and get a better idea about the quality of the work they are doing. Then, interview a few candidates, assess communication, compare all the info you’ve found and make your final choice.
