by Wyn Staheli, Director of Content - innoviHealth
Jul 8th, 2019
Question:
Are there scenarios in which it is acceptable to put the DC's NPI in box 24j for massage services?
Answer:
While the answer to this is yes, it is essential to understand that there are very limited scenarios. In most cases, Item Number 24J is only for the NPI of the individual who performed the service.
So when can another provider enter their NPI in this field? Medicare allows for the supervising provider’s NPI to be listed in 24J when it is “incident to”. We talked to many colleagues about this and even though we all agreed that “incident to” rules don’t really apply to chiropractors, there are some payers which may allow you to use the supervising provider’s NPI. In fact, some even require that the chiro’s NPI be reported in 24J when they are supervising a licensed massage therapist (LMT). This is the case with Highmark BlueCross in Pennsylvania.
It may not even matter if the patient is not seen by the DC on the same day. I know of one payer policy which will only pay for massage if it is on a different day than a CMT. Therefore, it comes down to payer policy and individual payer contracts. Carefully review your payer contracts and make sure you are doing it in accordance with their policy.
About Wyn Staheli, Director of Content - innoviHealth
Wyn Staheli is the Director of Content Research for innovHealth. She has over 30 years of experience in the healthcare industry. With her degree in Management Information Systems (MIS), she has been a programmer for a large insurance carrier as well as a California hospital system. She is also the author and editor of many medical resource books and the founder of InstaCode Institute.
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