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Q/A: Does My LMT need an NPI? How do I Bill Her Services?

By:  Wyn Staheli, Director of Research
Published:  October 22nd, 2018

Question:

I am setting up an LMT to work as employee under Dr. Clifton, DC. i need to know several things - hoping they are related and can be grouped into this one question.... does she need her own NPI? where does that NPI # go? what box #? if not, how do i indicated that she is the "provider of service" for the massage"

Answer:

You have a choice to bill either of the following ways:

  1. Bill directly under the LMT’s own NPI as a professional performing a service within his/her scope of practice and who independently reports that professional service, or

  2. As a clinical staff member, under the Doctor of Chiropractic’s NPI

Several organizations recommend that the LMT obtain their own NPI and bill the service directly. However, they would then need to be on the panel for the insurance company being billed, which may be difficult to do. Additionally, some payers, like original Medicare, do not cover massage (therapeutic or otherwise) as a benefit (see ABN for noncovered Services) while Medicare Advantage beneficiaries might have additional benefits providing coverage. This would be an independent, payer-specific issue.

Another important consideration is that some insurance policies require massage to be performed under the direction of the physicianso you will need to verify coverage and individual policies with the payer. How you proceed will depend on who you plan on billing. I’ve read that some auto and workers comp carriers acknowledge massage therapists, if billed independently. Bottom line is it depends on who you plan on billing and their policy.

Please note that if you are billing under the DC’s NPI, then the documentation needs to include the involvement of the DC in order to satisfy payer’s requirements for ‘supervision’.

As for the NPI placement on the claim form, it depends on which route you decide to take. If billing independently, then the LMT’s NPI goes on Item 24J and 33a. However, if billing under the DC, then the DC’s NPI goes on Item Number 33a instead.

For more information about the 1500 Claim Form, see Resource 178.

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