In Pennsylvania, massage therapists are now required to be licensed by the State Board of Massage Therapy. The Massage Therapy Law (63 P.S. §§ 627.1-627.50) and the regulations set forth the guidelines and define the scope of practice for licensed massage therapists (LMT) in Pennsylvania. The law and the regulations can be found on the PA Department of State website, and chiropractors who want to hire a massage therapist should review the new law.
Chiropractors who want to hire an LMT should consider hiring the LMT as an employee instead of an independent contractor. Generally, the IRS considers personnel as independent contractors only when strict criteria are met. However, when the chiropractor determines the LMT’s hours, controls how services will be performed, what services will be performed, etc., the IRS will most likely view the LMT as an employee and will expect the earnings of the LMT to be subject to withholding tax. In addition, some insurance payer rules require the LMT to be an employee in order for the insurance payer to reimburse for the massage therapy. All contracts between the chiropractor and the LMT should be in writing. As such, the chiropractor should consult an experienced health care attorney before hiring an LMT for consideration of these factors in addition to creating a compensation arrangement that is compliant with self-referral laws.
Massage therapy may or may not be covered under insurance plans. Some plans specifically exclude massage therapy while other plans cover the service only if medical necessity criteria are met. Medicare will not cover massage therapy if billed by a chiropractic office since spinal manipulation is the only Medicare covered service. Highmark Blue Shield has established a policy for coverage of massage therapy services billed through appropriate providers. This policy has been published in the PRN and on the internet. Insurance companies should continue to establish policies for massage in chiropractic offices and providers should carefully review notices and bulletins from their insurance payers.
LMTs should obtain an NPI number. Billing for an LMT’s services under a chiropractic license/office NPI number indicates the services are medically necessary. If the service is not medically necessary, then the patient should sign a notice confirming that the service is non-covered and the patient will be responsible for payment. Billing requirements may vary depending on the insurance policy and state law.
LMTs should also have their own liability/malpractice insurance. Insurance coverage will vary according to each policy and the chiropractor should always have his or her own liability policy evaluated if he or she hires a massage therapist.
It is unclear if the LMT’s services must be performed under the direct on-premises supervision of a licensed chiropractor. This rule generally applies to delegation of certain services to “unlicensed” supportive personnel. Since LMTs are now licensed, it would seem that this guideline does not apply to the LMT, but the Chiropractic Practice Act does not expressly address this issue. At a minimum, chiropractors should carefully review insurance guidelines for any supervision requirements and those should be strictly followed. To be safe, the chiropractor should consider on-premise direct supervision.