How to Write a Massage Referral

Massage can be a helpful therapy for a variety of neuromuscular dysfunctions as well as an effective treatment for pain, especially (but not exclusively) musculoskeletal pain.

Because it is a very safe and relatively low-cost treatment with very few contraindications, massage is increasingly recognized as a favored treatment alternative for managing pain and improving patient outcomes as part of an integrative healthcare team.

The body of evidence supporting massage as a treatment is still gaining strength, but it has already been accepted by a variety of payers and organizations, including the US Department of Veterans Affairs, the WA Department of Labor & Industries, and many health & medical insurers.

In Washington state, Licensed Massage Therapists (LMTs) are healthcare providers licensed and regulated as such by the Department of Health, and we bill a variety of insurers for that care - usually with a referral from an attending physician.

But how does an attending physician write a referral for massage? In many ways it is similar to a referral to see any other type of provider.  But there are a few things to keep in mind that will make the referral more effective:

• NPI: Include the referring provider's NPI on your referral. It is a required entry on the HCFA-1500 billing form and some insurers will not pay the claim if it is missing or incorrect. Your patient's LMT may be able to do an NPI lookup to find the correct NPI but it can sometimes be difficult to find the right provider, especially if you have a common name.
• DOI: Include the Date Of Injury for the relevant insurance claim. If it is an injury or condition without a certain date, a DOI should be established and used consistently so insurers can tell it is the correct claim.
• ICD-10 Codes: Include your diagnoses and the relevant ICD-10 codes (or whatever is the most current version of ICD). LMTs are not diagnosing providers so we cannot assign codes, and our bills will be denied if our codes do not match those used by the attending physician.
  
• Specify a massage provider: some patients may have their own massage provider they prefer to use. But others, especially patients who have not had massage before, are more likely to actually get the massage treatment if you suggest a provider to them. Finding a list of preferred massage providers can also give you the confidence that your patients are getting an effective treatment, and ultimately improve patient outcomes.
  
• Dosage/Frequency: for many physicians this is the most frustrating part of prescribing massage, as there are not readily-available guidelines for determining the proper dosage of massage. In truth, the most appropriate treatment frequency is very particular to each patient and condition. However, some insurers will require a referral to enumerate how many massage visits in order to be valid. WA L&I, for instance, will authorize 6 massages at a time, usually up to 12 but sometimes more sets of 6 with an additional referral from the attending physician and progress reports showing effectiveness and patient improvement. Treatment frequency for an acute injury typically ranges between 2x/week to 2x/month, depending on patient, particular condition/prognosis, and what other therapies are being used. (VA guidelines similarly quote "between 3-12 weeks in duration with 4-8 visits/treatments within that timeframe.") Treatment frequency for more chronic conditions/palliative care may be 1x/month, 1x/6 weeks, or as needed/prn; depending on how the patient's condition responds to treatments.
  

For more on the VA's use of massage therapy and their evidence map follow this link.