As open enrollment approaches, it’s essential to review your health insurance options carefully. Key factors to consider whether your plan offers out-of-network coverage and how it handles manual therapy services, specifically those classified under CPT Code 97140. This is the perfect time to ensure your policy aligns with your healthcare needs, particularly as additional services and treatments continue to evolve.
What is CPT Code 97140?
CPT Code 97140 is used to bill for manual therapy techniques like mobilization, and manipulation, often performed by physical therapists, chiropractors, or massage therapists. If your healthcare provider offers these services, you’ll want to verify how your insurance handles coverage, especially if the provider is considered out-of-network.
Some insurance plans cover manual therapy when provided by in-network providers, however, out-of-network coverage is more complex. Manual therapy coverage and reimbursement can vary greatly by plan, and insurance companies may place restrictions on the types of providers or services that qualify for reimbursement.
Additional Insurance Requirements
While licensed massage therapists can use pain codes, they are not in the scope to diagnose conditions. Some insurance plans may require a doctor's referral, along with diagnosis codes beyond pain, to ensure coverage.
Some health insurance plans require prior authorization or a referral from a doctor or chiropractor before approving coverage for manual therapies. It's a good idea to contact your insurance carrier directly to inquire about their specific requirements and, if needed, work with your healthcare provider to coordinate the necessary authorization.
Additionally, if you're involved in a motor vehicle accident (MVA) please reach out to your Kor team in advance as treatment, billing, and documentation must be referred and overseen by a doctor.
Out-of-Network Coverage and Manual Therapy
Out-of-network coverage allows you to see healthcare providers who don’t have contracts with your insurance company, but it generally comes with higher out-of-pocket costs. For services like manual therapy under CPT Code 97140, out-of-network benefits may require you to meet your deductible before any reimbursement takes place.
If you use manual therapy, as part of your healthcare routine, and your provider is not in-network, it’s crucial to understand if and how your plan reimburses out-of-network services. Some policies may only reimburse after a physician’s referral or may limit the number of visits per year that qualify for coverage.
Add-On Services and Products
In addition to manual therapy, Kor providers now offer advanced therapeutic services, such as:
• Electrons Plus
• Human Tecar
• Shiftwave Therapy
• Products for Recovery
These services and products may not fall directly under CPT Code 97140 but could potentially be included in coding for reimbursement. Kor continues to evolve its service offerings, and as new therapies become available, it’s important to ask your Kor team about whether these add-ons can be coded for insurance submission or reimbursed through your HSA or FSA accounts.
Understanding Superbills and Submitting for Reimbursement
A superbill is an itemized receipt that your out-of-network provider gives you, outlining the services rendered, including:
• Provider details (e.g., NPI)
• Diagnosis or pain codes (ICD-10)
• Procedure codes (CPT codes, such as 97140)
• Costs associated with each service
If your insurance plan covers out-of-network services, you can submit a superbill for reimbursement. This allows you to recoup some of the costs after meeting your out-of-network deductible. It’s essential to check with your insurer about the submission process and reimbursement rates to ensure timely compensation.
Using HSA and FSA Accounts for Out-of-Network Services and Add-Ons
Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) are tax-advantaged ways to pay for healthcare services. These accounts can be especially useful for out-of-network services, including the add-on therapies mentioned earlier.
• HSA: If you have a high-deductible health plan (HDHP), you likely qualify for an HSA. Contributions to HSAs are tax-deductible, and the funds can be used for any qualified medical expense, including manual therapy services, add-ons like Electrons+ therapy or recovery products. The funds in your HSA roll over each year, making it a flexible long-term savings tool for healthcare expenses.
• FSA: An FSA also allows you to use pre-tax dollars for healthcare expenses, but unlike an HSA, the funds typically expire at the end of the plan year. FSAs can still be used to cover out-of-network services, as well as the extra costs associated with add-on therapies and recovery products.
If your insurance doesn’t cover some of the add-on services or products directly, you can still use your HSA or FSA to pay for them, reducing your out-of-pocket costs by using pre-tax dollars.
Key Takeaways for Open Enrollment:
1. Review Out-of-Network Coverage: If you frequently use manual therapy or add-on services, make sure to check how your insurance handles out-of-network coverage, particularly for CPT Code 97140.
2. Consider Add-On Services: Ask your Kor team about whether add-on therapies like Electrons Plus, Human Tecar, or product can be reimbursed through insurance or applied to your HSA/FSA accounts.
3. Understand Reimbursement Rates: Clarify how much your plan will reimburse for out-of-network services and what percentage of your deductible must be met.
4. Prepare to Submit Superbills: Ensure your out-of-network provider offers superbills for submission, and confirm the insurance process to avoid reimbursement delays.
5. Maximize HSA/FSA Accounts: Utilize your HSA or FSA to cover out-of-network manual therapy, add-on services, and related products, minimizing your financial burden with tax-free contributions.
Open enrollment is your chance to align your insurance plan with your health needs, including flexibility for out-of-network services and growing therapeutic options. Make sure to review your plan’s coverage and reach out to your Kor team for additional guidance on the evolving services offered!
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