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Insurance Claims

It is your responsibility to seek insurance reimbursement for your myofascial release massage therapy treatment. Peak Performance Therapy, LLC. and/or Alex LaPierre LMT 012979 will not submit a claim for reimbursement on your behalf. This means that full payment for services to Alex LaPierre is required at the time of service, regardless of whether your insurance will reimburse you. No refunds will be administered or partial payments accepted pending approval or dismissal of a reimbursement claim.

Myofascial Release is classified as a “Manual Therapy Technique” for which the national treatment classification code is (CPT 97140). Massage Therapy may also involve and be coded as “Therapeutic Touch” (CPT 97799) and of course “Massage Therapy” (CPT 97124). Your doctor should write you a prescription detailing your conditions/diagnosis and requesting that you receive myofascial release massage therapy treatment and/or manual therapy technique under the appropriate listed codes. You may use the physician referral document below to begin the process.

Basic Steps to Submit a Claim

  1. Find out if your insurance covers massage therapy by an out-of-network provider, specifically by a licensed massage therapist (LMT). Some insurance providers will only cover massage/manual therapy by a chiropractor or a physical therapist (see instructions below)
  2. Request that your healthcare provider complete the attached Physician’s referral form, complete with the CPT code(s) listed above for Massage Therapy/Manual Therapy Techniques, and/or have your physician write an official prescription for this therapy (again, including CPT codes is important)
  3. After your treatment session, I will provide you with a superbill similar to the example offered on the second
  4. Submit your claim along with your prescription/ physician referral form and superbill to your insurance company

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Detailed Instructions

How do I find my massage therapy insurance benefits?

  1. Call the toll free # for customer service on your insurance card. Select the option that will allow you to speak with a customer service provider, not an automated system.
  2. Ask the customer service provider to quote your general massage herapy benefits. These are often referred to as “rehabilitation benefits” and can include physical therapy, speech therapy, and sometimes massage therapy.
  3. If you are planning on receiving telehealth/online massage therapy, please ask (a) if telehealth is covered and (b) at what rate.
  4. Ask if pre-authorization is required before treatment can begin.
  5. Make sure the customer service provider understands you are seeing to work with an out-of-network provider.

Filling our paperwork, What YOU need to know

  • Do you have a deductible? Yes/No If yes, how much is it? How much has already been met?
  • What percentage of reimbursement do you have? (60%, 80%, 90%, are all common)
  • Does the rate of reimbursement change because you’re seeing a non-preferred provider? Yes/No
  • Does your policy require a written prescription from your primary care physician? Yes/No
  • If yes, will a written prescription from any MD/physician, or a specialist your PCP (primary care physician) referred you to be accepted? Yes/No
  • Does your policy require pre-authorization or a referral on file for outpatient massage therapy services? Yes/No
  • If yes, do they have one on file? Yes/No
  • Is there a $ or visit limit per year? Yes/No If Yes, What is it?
  • Do you require a special form to be filled out to submit a claim? Yes/No How do I obtain it?
  • What is the mailing address you should submit claims/reimbursement forms to?
  • Is there an online website where you can submit the claim? Yes/No What is the address?

Understanding Insurance

  • A deductible must be satisfied before the insurance company will pay for therapy treatment. Submit all bills to help reach the deductible amount.
  • The reimbursement percentage will be based on your insurance company’s established “reasonable and customary/fair price” for the service codes rendered. This price will not necessarily match the charges billed; some may be less, some may be more.
  • If your policy requires a prescription or referral from your PCP you must obtain one to send in with the claim. This is usually not difficult to obtain if your PCP sent you to a specialist for help with your condition. If the referral from a MD or specialist is all you need, make sure to have a copy to include with your claim. Each time you receive an updated referral you’ll need to include it with the claim.
  • If your policy requires pre-authorization or a referral on file and the insurance company doesn’t have one listed yet, you’ll need to call the referral coordinator at your PCP’s office. Ask them to file a referral for your massage therapy treatment that is dated to cover your first Massage therapy visit. Be aware that referrals and pre-authorizations have an expiration date and some set a visit limit. If you are approaching the expiration date or visit limit you’ll need the referral

This worksheet was created to assist you in obtaining reimbursement for massage therapy services and is not a guarantee of reimbursement to you.