The Medical Massage Office
Manual 4th edition
David Luther and Margie
Callahan
WWW.TMMO.biz
CHAPTER # 14
Learning
Objectives
After completing
Chapter 14, the student will have an understanding of…
- How Usual and Customary charges are derived from Relative Value
Units, geographic area adjustments, and dollar conversion factors.
- How The Rules in Chapter
2 apply to Usual and Customary charges.
- The repercussions of not practicing true to the definitions of the
CPT™ codes.
- The importance of documenting curative care.
- The repercussions of charging for units beyond the expected time
MMI should be reached within the treatment.
- The repercussions of charging for units beyond the allowed amount
for the diagnosed body areas.
- The repercussions of charging too low or too high for units.
- Three reasons the massage industry has previously lacked
accountability.
- Why charges for patients are higher than for clients.
- Using National Fee Averages for finding Usual and Customary
charges.
- The importance of a posted price list and a signed copy on file
for each patient.
Within the system
that bona fide medical massage therapists want to practice, there is a
structure for the pricing of procedures and services. The system is known as Usual and Customary
(UC) charges. There is no debate about
UC charges. It is a system set up by the
AMA in conjunction with economic and medical realities, and insurers have every
reason to expect providers who bill them to follow this agreed-upon
system.
Usual and Customary charges
encompass several of the rules we have already stressed throughout this manual
that have to do with medical realities.
Choosing procedure codes that best represent what was provided is one
crucial aspect of achieving UC charges.
Treating only to Maximum Medical Improvement and within the units
allowed for the number of diagnosed body areas is also required for curative
results, and anything else does not qualify as Usual and Customary
charges. Introducing variables that
disqualify a treatment for UC charges has a negative impact on the system. This chapter demonstrates how to bill charges
that qualify as UC from both the economic
and medical standpoints.
While medical realities have to do with curative treatment and
appropriate treatment time (a.k.a. efficacy), the economic realities that comprise Usual and Customary charges have
to do with charging the appropriate amount for each unit based on the
education, skill, and operating costs that are required to provide the CPT™
procedure, and the appropriate amount for the type of insurance payor. There
are several types of payors involved: Government-subsidized insurers, private
insurance, and self-payors who do not have insurance. But if you are not paying attention to the
rules you learned about appropriate treating and charging (medical realities),
the economic realities you learn here will be meaningless.
The Board of Directors of
the American Medical Association appoints committees to direct CPT™ coding and
pricing. One of the committees they set
up is the Relative Unit Committee, a.k.a. RUC.
RUC gives every CPT™ procedure an initial value based upon the education,
skill, and operating costs that are required to provide the CPT™ procedure. The value of each procedure is known as the
Relative Value Units, or RVU. The RVU
provides a level starting point of charges for each CPT™ procedure or service
in the entire country. All of these economic realities are based on the
assumption that the medical reality
of curative care is taking place whenever a CPT™ code is billed.
The Significant Impact of
Improper Charging
Before we show you how to
use a formula that achieves the motives of the UC pricing system, we want to
share some misconceptions within the massage industry that result in a negative
impact on UC, and triggers the menacing scrutiny of all massage therapy
billing.
the assumption of curative care
A CPT™ procedure must first
be deemed curative to make its way into the CPT™ codebook. So the first assumption an insurer makes when
they pay a bill is that curative care took place. But just because a CPT™ code was billed
doesn’t mean curative care really took place.
First, the appropriate code must be utilized. Second, it is the context of the procedure
that makes it curative. Example: A massage therapist provides Swedish massage
for an hour. Insurance intended to pay for
treatment of a rotator cuff injury. So
billing 97124 for 4 units does not constitute curative care. This is an extreme example, but variations of
this problem are rampant.
Many massage therapists come
out of massage school with a one-hour full-body routine and don’t understand
that it doesn’t apply to medical massage.
They don’t know about Maximum Medical Improvement and don’t know enough
about specific and curative care. They
assume a prescription for massage means one hour of massage. We’re not saying
it’s their fault; in fact, that’s what we thought when we started billing
insurance. But things have changed since
then, and we need to get on board with what the insurance companies, doctors,
and patients want, or we will all be out of business.
When massage therapists
provide a one-hour routine of Swedish massage ala American, and even if they
throw in a modicum of manual therapy, therapeutic exercise, or neuromuscular
reeducation, it cannot be curative to the standards intended by the medical and
insurance industries. As already stated
in this book, Swedish massage techniques may be used to warm the tissues or
provide palliative care in the few instances it is called for, but curative
care comes from using manual therapy, neuromuscular reeducation, and
therapeutic exercise in accordance with the Current Procedural
Terminology. A scrap of these curative
therapies thrown in with wellness massage that is billed to insurance is not
appropriate. Insurance shouldn’t be
continually forced into paying for wellness massage just because they are stuck
with liability issues.
Both David and Margie have
spent endless hours countering published articles written by massage therapists
who argue that the way to handle the insurers who don’t want to pay for massage
is to bill for an hour but ask for less money!
This effectively lowers the per-unit charge. But lowering the per-unit charge is not the
answer. 1.) Providing curative care,
2.) in the appropriate amount of time, are what really matter.
Many of the articles insist:
Why should massage therapists cater to the system? We’ve always done it this way, so why should
we change? These massage therapists are
not considering their responsibility to be accountable for taking seriously the
meaning of the codes and the medical and insurance systems that pay them. They insist that the system is a mess and
this justifies their not taking part in it.
They believe their own system is better just because it is working for
them (but only because of insurer liability).
They believe they are providing curative care, and we grant that they
probably are, some of the time. But insurance is not intended to pay for
“curative care some of the time.”
The articles say that
insurers already know the efficacy of massage, and therefore they shouldn’t
have to prove it. This idea is
irresponsible and untrue. The purpose of
evaluations is to document the curative care that is taking place and that the
care is cost-effective (i.e., charges are for the appropriate time
allowance). Proper evaluations provide
this proof of efficacy.
A proper initial evaluation
is the starting point that directs a curative treatment, and efficacy is
documented by comparing the initial evaluation with progress reports and interim
evaluations. Along with the physician’s
documentation, our documentation justifies payment for the curative care we
bill to insurance. In the previous
example, curative care could not have been documented because an hour of
Swedish techniques cannot effect the cure of, say, a rotator cuff injury. Efficacy in the treatment of injuries is not
to be assumed, it is to be proven via proper evaluations and a documented
outcome that is expected as the result of curative and efficient
treatment.
The omission of curative
care causes lost faith in the providers who are billing for care that is not
producing the expected results. High
standards for evaluating, treating, and documenting that align with the high
standards of the medical and insurance industries is the only means by which
the medical massage industry can exist with integrity as a member of allied
healthcare.
Insurers can assume a code
is properly used only if the documented results meet the expected curative
results of the procedure. This is why
understanding the meaning of the CPT™ codes you bill, and following the
instructions to use the CPT™ code that best describes the procedure provided
are so important. If treatment results
do not meet expectations, it tells the story that a CPT™ code has been
misused. That is irresponsible
misrepresentation at best and fraud at worst.
Unfortunately,
too many massage therapists misuse codes, or simply provide Swedish massage and
bill 97124 for excessive time (via too many units) without understanding the
repercussions. Using 97124 in a limited
manner is its only legitimate use. This
is one of the reasons medical massage therapists fight downcoding. We don’t want insurers to accept the myth
that we only provide Swedish techniques.
Manual Therapy, Neuromuscular Re-education, and Therapeutic Exercise are
the vehicles through which we provide curative care.
True medical massage therapists recognize the necessity of
proficiency in Neuromuscular Re-education, Manual Therapy, Therapeutic
Exercise, Orthopedic Evaluation, and proper documentation. They also understand the problem of our
industry allowing some therapists to provide primarily Swedish massage for an
excessive amount of time and then lower the per-unit charge to try and make up
for deficiencies in cure (that they believe keeps the insurance companies happy
and paying them). However, the issue
insurance companies have is not about wanting to be charged less per unit
(although we agree that they probably appreciate—and laugh at—the price breaks
some therapists give them). The primary
issue they take up with massage therapists is charges for excessive time via
too many units.
Many treatments have been billed for an hour when they could have and
should have been billed for only a half hour. Automatic 4-unit charges are a
hindrance to the medical massage industry because it is excessive time and
gives insurance companies cause for not paying us. Until such time that we provide only curative
care when under prescription, this is the one of the best recourses insurers
can use to reduce excessive charges or mitigate their losses in paying for
non-curative care.
We hope our message in this chapter helps remedy this
problem. Remember, often the only reason
insurance companies pay us is to appease their customers and avoid
litigation. Since their customers love
massage, insurers are pretty much stuck paying for our treatments, curative or
not. The massage industry has held
itself back by allowing some of its factions to provide non-curative care
topped by the billing of excessive numbers of units. Fortunately, the massage industry is finally
checking on its own integrity in this game, through the work of the United
States Medical Massage Association and the Medical Massage National
Certification Board. The future is
bright.
Insurers continually monitor
the prices charged within regions, and shift UC charges accordingly. Those who lower their per-unit charges to
justify what they are not doing are cheating those who actually provide what
the procedure codes define and bill for time that represents efficacy. Those who believe that lower per-unit charges
are the way to keep insurance paying them do not understand how the system
works and the damage their actions cause.
The Expectation of
Accountability for Efficacy in Healthcare
Every healthcare provider
must be accountable for providing curative care. Unaccountability for curative care in the
massage industry has caused great frustration for the medical massage
therapists who deal with the ensuing collateral damage. These are the medical massage therapists who
provide the curative care that pull the statistics up enough to keep substandard
therapy in the game.
There are three reasons the
massage industry has previously lacked accountability: 1) The liability issues
that have kept insurers paying those who don’t deserve it, 2) The massage
industry not having standardized a higher set of skills that meet the
definition of curative, and 3) The massage industry not making the different
sets of skills known to the doctors who, because of this, unwittingly prescribe
non-curative massage along with curative massage.
Although the insurer
liability issue will remain, the massage industry finally has a system of
standards that meets the intended standards of the medical and insurance
systems many of us have chosen to work within.
Meanwhile, those who do not understand how the system is intended to
work do not notice the collateral damage they are causing to patients, medical
massage therapists, insurers, the general public that pays too much for
insurance because of wrongful billing, and the prescribing physicians who are
misled about where the efficacy of curative care in massage comes from.
As long as you are providing
curative care, charging the appropriate amount of units according the Rules in
Chapter 7, and using UC for the type of payor, you should not have problems
getting paid. Massage therapists who
misapply codes, charge excessive amounts and/or units, undercharge per unit, do
not provide curative care, and do not understand how to arrive at UC for the
type of payor create problems for all of us.
If you know of any massage therapist misunderstanding and misusing the
system in these ways, please advise them.
If they do not care, then please advise us, the authors, and we will
personally take up the issue with them, because we feel it is our duty, as
stated in our mission statement, to do what we can to maintain the well-being
of the medical massage industry.
“Good Cause” for Pricing
Differentials
Practicing medical massage
requires much more than when you treat clients who come to you with a
prescription. Providing prescribed
medical massage to treat injuries is a matter of providing a higher level of
service that requires more knowledge, responsibilities, time, effort, and
expense above massage therapy provided as a personal service.
In the NON-medical massage
model (involving CLIENTS, not patients), a massage therapist has no
restrictions on setting charges other than what the market will bear. The time, knowledge, and responsibilities
necessary to the practice of medical massage differ greatly from the non-medical
model, and charges should reflect these differences within Usual and Customary
charges.
When the massage therapist chooses to work
within the medical model, they have agreed to accept PATIENTS while they may
still have CLIENTS. While the
relationship with and charges to their CLIENTS should remain the same for that
level of service, their charges to ALL PATIENTS should reflect the higher level
of service. The patients the doctor
refers to a medical massage therapist inherently receive a different service
than clients, and must be charged a fee that reflects the additional time,
effort, and expense due to the required knowledge and responsibilities. The authors believe that the following “good
cause” statement by the Office of the Inspector General supports this.
A medical equipment retailer
wanted to “charge Medicare prices which are higher than it charges retail
customers for the same products.” The
OIG’s Advisory Opinion 98-8 re: Discounts states:
“if the higher costs are ‘due to
unusual circumstances or medical complications requiring additional time,
effort, expense or other good cause,’ due to claims processing, documentation…
and delays/denials in Medicare payment, then suppliers are allowed to charge
Medicare more than their ‘usual charge’.”
Because insurance industry
standards very often comply with Medicare standards, the OIG’s opinion may be
applicable to all medical massage insurance claims. Whether patients pay you directly or
insurance pays you, prescribed medical massage still requires considerably more
time, effort and expense than non-medical massage. The Different
Levels of Service chart below makes clear the dramatic differences in
levels of service for CLIENTS versus PATIENTS.
Notice the service for a SELF-PAYING PATIENT and INSURANCE PATIENT are
very similar, while the differences between the CLIENT and the two types of
PATIENT are huge. If someone comes to
you with a prescription for medically necessary massage and pays you directly,
you will follow the protocol of charging for a self-paying PATIENT and you will
bill at your PATIENT rate because you are rendering services similar to that
which you render to insurance patients.
We support this statement further in the next section on Price Discrimination.
Sometimes
a patient has a prescription but no insurance.
You are not required to treat a person at the patient level of service
just because they have a prescription.
You are not required to take the prescription, and if you do not, you
can choose to forgo the higher level of service and charge at the client rate
to make it more affordable. However, we
offer this caveat: Be careful about the
actual level of service you provide, and be alert to how quickly this can
change. For example, if you take a lien from an attorney, your
services are automatically increased from the level of client to patient, and
you need to take all the steps required of patient-level service for your and
the patient’s protection. Another
example would be if you communicate with the doctor or anyone else about the
patient’s case, which is illegal until you take steps to make it legal.
If
a client suddenly needs you to increase prior client services to the patient
level, you can give copies of your office notes or reports to the client
without receiving patient-level compensation, but do not give anything to
anyone else, such as the doctor, the insurer, or an attorney until such point
that the client is converted to a patient at the completion of appropriate
compensation and patient signature on your HIPAA privacy notice and other
documents. This is for your own protection as well as the patient’s. Until all appropriate paperwork is completed,
you have no legal relationship with the patient’s doctor, attorney, or
insurance, and it is strictly up to the client to give out their private
information, while it is illegal for you to do so until the patient signs that
right over to you and pays you accordingly.
If
you have not been producing the type of S.O.A.P., story-format reports you
normally do for insurance and the doctor, be sure to mark your checksheet with
large letters: “IN-OFFICE NOTES
ONLY. NOT FOR PRESENTATION TO DOCTOR OR
INSURANCE. STORY-FORMAT S.O.A.P. NOTES AVAILABLE UPON COMPLETION OF APPROPRIATE
PAPERWORK AND PAYMENT OF APPROPRIATE SERVICE-LEVEL COMPENSATION.” Do not turn ANY of the client file over to
insurance or the doctor or an attorney, or anyone other than the patient or
their legal guardian until the conversion from client to patient is complete.
How Usual
and Customary Works Within the Free Market System
The
UC system was set up to work as follows: A Relative
Value of every CPT™ code is first established, as already explained. Next, a percentage multiplier for variations
in expenses between geographic areas
then adjusts the Relative Value of every CPT™ procedure code. This allows the marketplace to have some
force in the price of healthcare.
Finally, a dollar conversion
factor is applied to yield a fee that is acceptable to the provider’s or
payor’s financial objectives. For
example, the dollar conversion factor for billing private auto or work injury
insurance will be higher than for Medicare, Medicaid, and state work injury
insurance. This helps the
government-subsidized insurers meet their financial objectives while keeping
private insurance paying enough so
that
the supply of healthcare providers doesn’t dry up. So you see, even private insurance companies
do their part.
We
mentioned earlier in this chapter that once UC is established for a region,
insurance companies monitor and shift the accepted UC by how much providers are
charging for procedures within a recent time period within a given region. This is another way that allows marketplace
forces to affect pricing. If your
per-unit charges exceed UC, insurance will pay you what they determine to be
UC. (If your number of units exceeds UC,
they will not pay you, and you have trouble on your hands.) Although UC may shift and change within each
year, fee changes are published annually, and you will want to have a current
edition of the National Fee Analyzer
or other medical reimbursement guide to stay reasonably close to current UC
charges for your area. Otherwise, you
will waste a lot of your and the insurance companies’ time, and may bring a
rash of unreasonable scrutiny onto the entire medical massage industry. The National
Fee Analyzer is published annually by Ingenix and sold by Medicode. To order it, call Medicode at 1-800-999-4600.
Using National Fee Averages
The National Fee Analyzer is a commonly used reference book that
provides annually updated percentiles of average national charge data for each
procedure code. The percentile amount
tells the percentage of surveyed healthcare providers who charged the listed
price or less. This analysis saves
providers from the guesswork of where insurers are at with UC based on
individual decisions within regions and a current time period about
profit. The percentile replaces the
dollar conversion factor, and is chosen based on the type of insurance the
provider is billing. The chosen
percentile of charges is multiplied by the geographic conversion factor for the
region where charges are taking place.
This reduction to two steps allows providers to quickly find the
percentile that reflects pricing that will be satisfactory to the type of
insurer being billed. Using this easier
system is acceptable and saves time.
The 75th percentile is
appropriate for charges to auto and private work injury insurance. Find the 75th percentile of
charges for a procedure you provide.
For state work injury insurance,
you will need to contact your state’s office as addressed in an earlier chapter. You may also go online at www.workerscomp.org and conduct a
keyword search for your state’s acceptable charges.
75TH PERCENTILE OF CHARGES
97110 57.39 97002 69.38
97140 43.96 99054 62.12
97010 28.50 99056 81.03
97014 32.07 99058 83.73
97032 37.16 99075 no
stats
97035 36.52 99080 no stats
97001 138.77
CPT™ only Copyright 2005 American Medical
Association. All Rights Reserved.
Now that you have an average
nationwide price that reflects average cost and the type of insurance you are
billing, take that price and multiply by the appropriate Geographic Conversion
Factor for your region, listed in the chart that follows. The GCF reflects both the cost of living and
the provider expense adjustment.
The formula of multiplying the 75th
percentile by the GCF tells you that 75% of other providers in your area are
charging that amount or less, while 25% are charging more. Because we do live in a market economy, you
may use your own discretion in setting your own charges while knowing where
insurance expects you to be. This should
be a charge that is very likely to be acceptable to the private insurance
companies you are billing—unless there are a number of fools in your area who
charge inappropriately low to justify providing less than the procedures call
for, and suddenly bring the UC average unreasonably down.
geographic adjustments
Alabama
Birmingham, 0.811
Florence,
Huntsville, Decatur 0.755
Gadsden,
Anniston 0.723
Mobile, Prichard 0.735
Montgomery, Dothan, Monroeville,
Selma 0.735
Tuscaloosa, Bessemer, Collman 0.743
Alaska
Fairbanks,
Anchorage 1.263
Juneau, Kodiak 1.128
Ketchikan,Wrangell 1.157
Arizona
Flagstaff,
Window Rock 0.929
Mesa, Tempe,
Scottsdale 0.954
Phoenix 0.973
Prescott,
Kingman, Globe 0.896
Tucson And Area 0.892
Arkansas
Jonesboro,
Fayetteville, Fort Smith 0.876
Little Rock And
Area 0.840
Pine Bluff, Hot
Springs, Russellville 0.810
Fee data and the geographic adjustment factors are
used by permission of Medicode.
California
Bakersfield,
Visalia, Lancaster0.901
Burbank, North
Hollywood 0.889
Downtown Los
Angeles 1.137
Escondido,
Vista, Oceanside 0.930
Fresno, Clovis,
Madera 0.910
Glendale,
Arcadia 0.975
Long Beach,
Torrance, Whittier 0.997
Oakland,
Berkeley, Fremont, Napa 1.008
Ontario, Pomona,
W Covina, Alhambra 0.981
Oxnard, Ventura 0.970
Palo Alto 1.379
Pasadena 1.023
Redwood City,
South San Francisco 1.093
Riverside, San Bernardino, Palm
Springs 0.935
Sacramento, 1.179
Salinas, Seaside, King City 0.992
San Diego 1.053
San Francisco 1.227
San Jose, Santa
Clara, Santa Cruz 1.085
San Mateo 1.002
Santa Ana, Anaheim,
Newport Beach 0.987
Santa Barbara 1.003
Santa Clarita, Van Nuys 1.060
Santa Maria, San
Luis Obispo, 0.867
Santa Monica,
Inglewood,
Redondo Beach 1.036
Santa Rosa,
Redding, Chico, Yuba City 1.027
Stockton,
Modesto, Merced, Lodi 0.956
Woodland, Davis,
Placerville 0.905
Colorado
Arvada, Boulder, Golden 0.999
Aspen, Glenwood
Springs, Vail 1.028
Castlewood,
Highlands Ranch 0.995
Colorado Springs, Pueblo 0.978
Denver 0.972
Fort Collins,
Greeley, Sterling 0.946
Grand Junction,
Durango, Alamosa 0.896
Connecticut
Bristol,
New London 1.065
Hartford 1.110
Meriden, Torrington, Waterbury 1.060
New Haven,
Bridgeport 1.058
Stamford,
Norwalk, Danbury 1.129
Fee data and the geographic
adjustment factors are used by permission of Medicode.
Delaware
Dover,
Georgetown 0916
Newark,
Wilmington 0.990
District of Columbia
Washington DC 1.074
Florida
Altamonte
Springs, Kissimmee, Deltona 0.995
Daytona Beach, Port Orange 0.903
Fort Lauderdale 1.117
Fort Myers 0.927
Fort Pierce,
Stuart, Palm City 0.961
Gainsville 0.846
Jacksonville 0.985
Kendall, Hialeah 1.088
Lakeland,
Bartow, Sebring 0.911
Lakeside, Lake City, Live Oak 0.929
Melbourne, Palm Bay, Merritt
Island 0.886
Miami 1.117
Naples, Bonita Springs 1.024
Ocala, Inverness 0.795
Orlando, 1.001
Sarasota, Clearwater, Spring
Hill 0.843
St. Petersburg, Lutz 0.938
Tallahassee,
Pensacola, Panama City 0.901
Tampa 1.022
West Palm Beach,
Lake Worth 0.980
Georgia
Albany, Columbus 0.975
Atlanta 1.070
Augusta, Athens,
Dalton, Gainesville 0.934
La Grange, Rome,
Douglasville 0.991
Macon, Milledgeville 0.976
Marietta,
Smyrna, Roswell 1.021
Savannah, Hinesville 0.988
Statesboro, Waycross, Valdosta 0.918
Hawaii
Hawaii 0.953
Fee data and the geographic
adjustment factors are used by permission of Medicode.
Idaho
Boise 0.879
Idaho Falls,
Pocatello, Rexburg 0.801
Lewiston,
Moscow, Twin Falls 0.850
Illinois
Aurora,
Naperville, Downers 1.087
Belleville,
Carbondale, Marion 0.887
Bloomington, Pontiac 1.044
Champaign, Urbana, Rantoul 1.252
Charleston,
Paris 0.984
Chicago 1.167
Effingham, Centralia 0.867
Elgin, Oak Park 1.188
Freeport, Rock
Island 0.899
Galesburg, Pekin, Kewanee 0.859
Granite City,
Hillsboro, Jersyville 0.926
Joliet, Oak Lawn, Harvey 1.057
Kankakee, Paxton 0.912
Peoria 0.960
Quincy, Decatur,
Jacksonville 0.942
Rockford 1.064
Springfield 1.077
Waukegan,
Arlington Heights, Evanston 1.089
Indiana
Anderson, Muncie, Indianapolis
Area 0.922
Bloomington, Terre Haute, New
Albany 0.902
Evansville, Vincennes,
Washington 0.925
Fort Wayne, Huntington 0.883
Gary, Hammond, East Chicago 1.001
Indianapolis, Lawrence 1.026
Kokomo, Lafayette, Marion 1.075
South Bend, Mishawaka, Elkhart,
Goshen 0.959
Iowa
Council Bluffs,
Creston, Sheldon 0.804
Des Moines,
Marshalltown, Ames 0.872
Dubuque, Davenport, Cedar Rapids 0.857
Mason City,
Waterloo, Decorah, Spencer 0.887
Sioux City 0.915
Fee data and the geographic
adjustment factors are used by permission of Medicode.
Kansas
Kansas City,
Lawrence 0.854
Manhatten, Holten, Emporia 0.771
Newton, El
Dorado, Independence 0.815
Overland Park,
Shawnee, Prairie Village 0.906
Salina,
Hutchinson, Dodge City 0.805
Topeka, 0.860
Wichita 0.871
Kentucky
Corbin, Harlan,
Somerset,
Elizabethtown 0.832
Fort. Knox,
Radcliff, Lebanon 0.841
Lexington-Fayette, Frankfort, 0.969
Louisville, Fern Creek, Okolona 0.896
Middlesborough,
Ashland, Pikeville 0.951
Nicholasville,
Danville, Florence 0.866
Owensboro,
Hopkinsville,
Bowling Green 0.866
Louisiana
Baton Rouge, New
Roads, Gonzales 0.911
Chalmette,
Laplace, Slidell 0.955
Lafayette, Lake
Charles, Houma 0.909
New Orleans 0.978
Shreveport, Alexandria, Monroe 0.935
Maine
Augusta, Presque
Isle, Waterville 0.886
Bangor,
Ellsworth, Rockland, Woolrich 0.873
Biddeford,
Sanford 0.886
Lewiston,
Androscoggin 0.999
Portland 1.024
Maryland
Baltimore,
Dundalk, Towson 1.043
Bowie,
Greenbelt, Coral Hills 1.041
Columbia, Annapolis, Bel Air South 0.931
Easton,
Salisbury, 0.833
Frederick,
Hagerstown, Cumberland 0.859
Silver Spring,
Bethesda, Gaithersburg 1.026
St. Charles, Waldorf, Lexington
Park 0.957
Fee data and the geographic
adjustment factors are used by permission of Medicode.
Massachusetts
Belmont,
Lexington, Watertown 1.044
Boston,
Cambridge 1.090
Brockton, Fall
River, New Bedford 0.946
Buzzards Bay,
Barnstable 0.966
Fitchburg,
Leominster, Greenfield 1.014
Holden,
Southbridge, Uxbridge 1.042
Lowell, Lynn,
Lawrence 1.004
Natick, Maynard 1.005
Pittsfield,
North Adams 0.935
Springfield,
Chicopee, 0.998
Worcester, 1.069
Michigan
Ann
Arbor, Dearborn, Wyandotte 0.901
Detroit 0.944
Escanaba, Marquette 0.960
Flint, Burton 0.849
Grand Rapids,
Muskegon, Cadillac,
Alpena 0.827
Kalamazoo,
Battle Creek, Jackson 0.846
Lansing, Mount
Pleasant, Okemos 0.808
Pontiac 0.886
Saginaw, Bay
City, Midland 0.872
Troy, Roseville,
Port Huron 0.885
Minnesota
Anoka, Chaska,
Watertown 1.069
Brainerd,
St. Cloud, Little Falls 0.946
Duluth 1.054
Hastings,
Northfield, Stillwater 1.118
Mankato 1.032
Minneapolis,
Bloomington, Edina 1.060
Moorhead,
Hibbing, Bemidji 0.965
Rochester, Winona,
Austin 1.214
St. Paul 1.033
Wilmar, Morris,
Windom 0.957
Mississippi
Grenada,
Meridian, Yazoo City 0.884
Hattiesburg,
Biloxi, Brookhaven 0.886
Jackson 0.924
Oxford, Ripley, Southaven 0.957
Tupelo, Greenville, Columbus 0.868
Fee data and the geographic adjustment factors are
used by permission of Medicode.
Missouri
Cape Girardeau,
Farmington 0.888
Carthage,
Branson, West Plains 0.855
Charleston,
Poplar Bluff, Rolla 0.852
Jefferson City,
Columbia, Mexico 0.936
Kansas City, Independence 0.915
Springfield 0.969
St. Charles,
Chesterfield, Hannibal 0.896
St. Joseph, Kirksville,
Chillicothe 0.829
St. Louis And
Area 0.994
Montana
Billings,
Lockwood 0.932
Great Falls,
Butte-Silver Bow 0.816
Missoula 0.881
Nebraska
Lincoln 0.921
North Platte,
Scottsbluff, Norfolk 0.811
Omaha, Bellevue,
Freemont 0.897
Nevada
Las Vegas And
Area 1.049
Reno, Nevada
Miscellaneous 0.981
New Hampshire
Concord, Keene,
Lebanon 0.979
Dover,
Portsmouth, Rochester 0.890
Manchester,
Nashua 1.005
New Jersey
Brick Township,
Lakewood 0.979
Edison,
Somerville 1.061
Middletown, Trenton 1.023
Morristown,
Shore Hills, Dover 1.044
New Brunswick 1.269
Newark, Jersey
City, 1.173
Paterson,
Hackensack 1.124
South Jersey 0.999
Union City
Elizabeth 1.078
Fee data and the geographic adjustment factors are
used by permission of Medicode.
New Mexico
Albuquerque 0.917
Gallup, Santa
Fe, Grants 0.957
Las Cruces, Roswell.
Alamogordo 0.935
New York
Albany,
Schenectady, Kingston 0.903
Binghamton,
Vestal, Oneonta 0.888
Brooklyn,
Queens, Jamaica 1.165
Buffalo, Niagara
Falls 0.740
Jamestown, Olean 0.801
Manhattan 1.379
Nassau And
Suffolk Counties 1.080
New Rochelle,
Yonkers, Somers 1.084
Plattsburgh,
Glen Falls 0.897
Poughkeepsie,
Beekman, Monticello 0.965
Rochester,
Elmira, Ithaca 0.894
Rockland County,
New City 1.010
Staten Island,
Bronx 1.089
Syracuse,
Auburn, Cortland 0.882
Utica, Rome,
Watertown 0.903
White Plains, 1.193
North Carolina
Asheville,
Hickory, Western NC 0.924
Cary, Goldsboro 0.978
Charlotte 1.083
Durham 1.152
Fayetteville,
Jacksonville, Wilmington 0.958
Gastonia,
Kannapolis, Monroe 0.964
Greensboro,
Highpoint, Burlington 1.176
Raleigh, 1.039
Winston-Salem 0.969
North Dakota
Bismarck, Minot,
Grand Forks 0.932
Fargo 0.969
Fee data and the geographic adjustment factors are
used by permission of Medicode.
Ohio
Akron,
Stowe, Kent 0.919
Canton 0.866
Cincinnati 0.902
Cleveland 1.029
Columbus 0.983
Dayton, Beaver
Creek 0.939
Elyria, Mentor 0.967
Hamilton,
Middletown, Portsmouth 0.898
Lima, Findlay 0.870
Mansfield 0.904
Marion, Norwalk,
Tiffin 0.901
Newark,
Westerville, Lancaster 0.942
Springfield, Fairborn, Xenia 0.851
Toledo, Bowling
Green 0.936
Youngstown, Warren 0.827
Zanesville,
Massillon, Cambridge 0.868
Oklahoma
Enid, Ponca
City, Woodward 0.810
Lawton, Durant,
McAlester 0.847
Muskogee
Shawnee, Miami 0.848
Oklahoma City,
Edmund, Norman 0.908
Tulsa,
Bartlesville, Stillwater 0.893
Oregon
Beaverton,
Hillsboro 1.000
Eugene,
Altamont, Bend, Medford 0.957
Pendleton, Baker
City, Ontario 0.762
Portland 1.035
Salem,
Corvallis, Albany 0.968
Pennsylvania
Allentown,
Easton, 0.860
Altoona,
Huntingdon 0.853
Beaver Falls,
McCandless 0.830
Butler, Clarion,
New Castle 0.834
Carbondale,
Scranton 0.801
Chambersburg,
York, Ephrata 0.816
Du Bois, Oil
City, Bradford 0.832
Erie,
Union City 0.911
Greensburg,
Johnstown 0.781
Fee data and the geographic adjustment factors are
used by permission of Medicode.
Pennsylvania (continued)
Harrisburg,
Lebanon, Hampden 0.859
Hazleton,
Wilkes-Barre 0.930
Indiana,
Punxsutawney, Bell 1.009
Lancaster 1.033
Norristown,
Warminster, West Chester 1.172
Philadelphia 1.047
Philadelphia
Area, Leavittown,
Upper Darby 0.987
Pittsburgh 0.960
Reading,
Pottsville, Muhlenberg 0.773
Stroudsburg,
Pocono, Milford 0.955
Washington,
Uniontown, Somerset 0.841
Williamsport,
Sunbury, Wellsboro 0.870
Puerto Rico
Puerto Rico 0.664
Rhode Island
Rhode Island 0.904
South Carolina
Aiken,
Hilton Head Island 0.924
Charleston,
Summerville 0.935
Columbia 0.910
Greenville,
Anderson 0.920
Spartanburg, Rock Hill 0.921
Sumter, Orangeburg 0.900
South Dakota
Rapid City,
Mitchell, Watertown
Yankton 0.867
Sioux Falls 0.957
Tennessee
Brownsville,
Dyersburg 0.986
Chattanooga,
Tullahoma 0.972
Clarksville, Columbia,
Murfreesboro 0.945
Cookeville,
Johnson City, Morristown 0.921
Knoxville 0.973
Memphis 1.025
Nashville 1.035
Union City,
Jackson 0.941
Fee data and the geographic
adjustment factors are used by permission of Medicode.
Texas
Abilene, Lubbock 0.949
Amarillo,
Plainview, Dumas 0.923
Arlington, Fort Worth 1.016
Austin, San Marcos, LaGrange 1.087
Beaumont, Port
Arthur 1.000
Brownsville,
McAllen 1.019
Conroe,
Pasadena, Galveston 0.992
Corpus Christi,
Portland 0.868
Dallas 1.167
El Paso 0.932
Garland, Irving,
Sherman, Denison 1.063
Houston 1.092
Killeen, Bryan, College Station 1.003
Longview, Tyler,
Lufkin 1.001
San Angelo,
Odessa, Del Rio, Midland 0.963
San Antonio,
Laredo, Kerrville 0.987
Victoria,
Beeville, Karnes City 0.902
Wichita Falls,
Denton 1.007
Utah
Ogden, Logan,
Brigham City 0.779
Provo, Cedar
City, St. George, Moab 0.785
Salt Lake City 0.806
Sandy, Orem,
West Jordan, Layton 0.784
Vermont
Burlington, St.
Albans 1.019
White River
Junction, Montpelier 0.867
Virgin Islands
Virgin
Islands 0.664
Virginia
Arlington,
Alexandria 1.030
Charlottesville,
Harrisonburg, Winchester 0.849
Fredericksburg,
Tappahannock 0.954
Lynchburg, Chase
City 0.822
Manassas,
Leesburg, Falls Church 1.010
Richmond, Petersburg, 0.891
Roanoke,
Wytheville, Tazewell 0.920
Virginia Beach, Norfolk, Newport
News 0.909
Fee data and the geographic
adjustment factors are used by permission of Medicode.
Washington
Bellevue, Kent,
Kirkland 0.954
Everett,
Bellingham 0.905
Olympia,
Centralia, Lacey 0.946
Seattle 0.971
Spokane, Pullman 0.791
Tacoma,
Bremerton, Port Angeles 0.934
Vancouver,
Kelso, Hazel Dell 0.986
Yakima, Richland, Walla Walla 0.897
West Virginia
Charleston,
Huntington, Summersville 1.002
Fairmont,
Morgantown, Wheeling 0.982
Parkersburg, Martinsburg, Clarksburg 0.894
Wisconsin
Ea Claire,
Menomonie, Chippewa Falls 1.219
Green Bay 1.207
Janesville,
Beloit, Southwest Wis. 1.155
La Crosse,
Sparta, Tomah 1.259
Madison 1.332
Manitowoc,
Kaukauna, Marinette 1.160
Milwaukee 1.247
Oshkosh, Appleton,
Fond Du Lac 1.110
Portage, Beaver Dam, Montello 1.128
Racine 1.170
River Falls
Rhinelander, Spooner 1.095
Sheboygan, West
Bend 1.240
Waukesha,
Elkhorn, Muskego 1.192
Wausau,
Wisconsin Rapids 1.198
Wyoming
Wyoming 0.826
After calculating usual and customary charges, you
can see that you will be able to make a great living if you work diligently to
build your practice, follow the rules, and serve by the expected medical
standards in spite of all the extra services required over wellness/spa
massage.
Fee data and the geographic adjustment factors are
used by permission of Medicode.
