LymphActivist's Site
Dedicated to Lymphedema Patients and the Therapists Who Treat Them
LymphActivist's Site
Dedicated to Lymphedema Patients and the Therapists Who Treat Them
LymphActivist's Site
Dedicated to Lymphedema Patients and the Therapists Who Treat Them
I am a licensed massage therapist. Is there any way I can receive reimbursement for my services to Medicare Beneficiaries?
You are in a tough situation, since Medicare does not reimburse for bandages or for garments, nor do they reimburse for the services of a massage therapist. Most, but not all, insurance companies have policies which coincide with Medicare. Medicaid could go either way since it is state sponsored, but since most states are strapped for funds it is less likely each year to receive reimbursement for lymphedema services.
The governing documents for Medicare are the Local Coverage Determinations for Outpatient Therapy in your Medicare region and the Medical Policies of the Healthcare insurers who serve your region.
The basic national governing Medicare documentation is a series of "Internet Only" publications available at: http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs.html
You will want to read up on the "incident to the services of a physician" and the "outpatient therapy" policies and see where they lead you.
The rules are different when discussing insurance reimbursement VERSUS Medicare reimbursement. In addition to the State licensing rules, which Medicare recognizes, there is a statute that governs who can be reimbursed for providing THERAPY SERVICES to Medicare patients. The provisions of the Code of Federal Regulations (CFR) 42 C.F.R. 484.4 Personnel Qualifications are summarized in the Medicare Benefit Policy Manual, CMS Publication 100-02, Chapter 15, §220 as follows:
QUALIFIED PERSONNEL means staff (auxiliary personnel) who have been educated and trained as therapists and qualify to furnish therapy services only under direct supervision incident to a physician or NPP. See §230.5 of this chapter. Qualified personnel may or may not be licensed as therapists but meet all of the requirements for therapists with the exception of licensure.
The term "educated and trained as therapists" is defined in 42CFR484.4:
Physical therapist. A person who is licensed, if applicable, by the State in which practicing, unless licensure does not apply and meets one of the following ?requirements:
(a)(1) Graduated after successful completion of a physical therapist education program approved by one of the following:
(2) Passed an examination for physical therapists approved by the State in which physical therapy services are provided.
Similar requirements pertain to occupational therapists.
Massage therapists and athletic trainers are explicitly precluded from providing Medicare therapy services in the Medicare Benefit Policy Manual, CMS Pub 100-02, Chapter 15, §230.5 as follows:
Regardless of any state licensing that allows other health professionals to provide therapy services, Medicare is authorized to pay only for services provided by those trained specifically in physical therapy, occupational therapy or speech-language pathology. That means that the services of athletic trainers, massage therapists, recreation therapists, kinesiotherapists, low vision specialists or any other profession may not be billed as therapy services.