Navigating the complexities of health insurance billing for massage therapy in Virginia can feel daunting, often leaving practitioners unsure of how to get fairly compensated while providing vital care to patients. As medical massage becomes a more recognized component of rehabilitation, understanding how to transition from cash-based services to insurance reimbursement—specifically navigating CPT codes like 97124 or 97140—is crucial for elevating not only one's practice, but also the profession as a whole. This guide will break down the nuances of the Virginia landscape, explaining how fair value rates are established through [Resource-Based Relative Value Scales (RBRVS)] and local market analysis.
The two primary organizations that set the fee schedules for direct billing rates are the Center for Medicare and Medicaid Services (CMS), which is at the federal level, and the Virginia Department of Medical Assistance Services (DMAS), which is at the state level.
Those two organizations work with a third organization called the American Medical Association Specialty Society Relative Value Scale Update Committee, (RUC) which provides CMS and DMAS recommendations on fair value rates for their fee schedules.
The RUC is a panel of 32 physicians that works with over 300 specialty advisors to value physician work by evaluating the necessary staff, equipment, and supplies needed for services. They gather data throughout the year and then use what’s called a Resource Based Relative Value Scale (RBRVS) to determine the relative value units (RVUs) for medical services.
The components of the RBRVS formula include:
Physician work RVU: Measures factors like time, intensity, technical skill, performance and mental effort, judgement, and stress associated with the service.
Practice Expense RVU: Covers Overhead Costs
Malpractice RVU: Accounts for professional Liability Insurance
Geographical Practice Cost Index (GPCI): Which adjusts for regional cost differences.
The equation for the formula looks like this:
(Work RVU x Work GPCI) + (PE RVU x PE GPCI) + (MP RVU x MP GPCI) = Total Adjusted RVU
The total Adjusted RVU then gets multiplied by a Conversion Factor which is an annual dollar multiplier that converts the RVUs into a payment amount, and that’s how the direct billing rates are determined.
Medical professionals direct bill using what are called Current Procedural Terminology or CPT codes.
There are two primary CPT codes that Licensed Massage Therapists can bill, codes 97124 and code 97140.
Code 97124 is defined as “Massage Therapy” and covers techniques like effleurage, petrissage, and tapotement to improve circulation, muscle relaxation, and soft tissue stimulation. Massage therapists will recognize this as standard Swedish Massage.
Code 97140 is defined as “Manual Therapy” and covers techniques such as mobilization, manipulation, manual lymphatic drainage, and traction applied to improve range of motion and reduce pain. These could be described as more advanced practice modalities, orthopedic massage, structural integration, or myofascial release.
Current fair values direct billing rates for both CPT codes and be looked up on the CMS and DMAS websites, and get updated every year on July 1st.
Current Virginia Direct Billing Rates For codes 97124 and 97140 are $26.14 and $29.84 respectively.
Each code is billed in a Unit of 15 Minutes of Treatment, with 8 minutes being the minimum amount of direct application time needed for compensation to be approved.
An insured can only be covered for a maximum of 4 Units of treatment per week, equaling an hour total of treatment time per week.
The Fair Value Rate for 1 hour conventional treatment time frames for 2026 is: CPT Code 97214 - $104.56, CPT Code 97140- $119.36
