Veterans Administration: Massage Therapy Reimbursement Issues

AMTA has heard from many massage therapists who contract with the Department of Veterans Affairs (VA) through the Community Care Network (CCN), regarding recent cuts to service-related reimbursement rates (the fee schedule).

Early in 2024, AMTA also became aware of similar concerns expressed on Capitol Hill by Rep. Chris Pappas (D-NH) to the VA Representative. Rep. Pappas has been taking action as a result of massage therapy cuts in his district in New Hampshire, which have directly impacted his constituents.

AMTA responded by meeting with Rep. Pappas’ office in Washington DC. We also met with the VA staff responsible for overseeing the massage therapy program, as well as the senior staff for Optum Health (the third-party plan administrator for the VA CCN). Reimbursement for all services provided under federal payors is complex, and massage therapy is no exception.

Below is a summary of our own research into the CCN’s massage reimbursement policies and the findings from our meetings, which are still ongoing. We hope this information provides some clarity as to why massage therapy fee schedules may fluctuate:

• Massage therapy for the VA is reimbursed under fee schedules set by the Centers for Medicare and Medicaid Services (CMS). The VA or Optum do not set its own fees when CMS has already done so for a specific service. These fees are updated at least annually – and sometimes more – in rulemaking processes that involve draft regulations, public comments, and publication of final fees.

• Because the massage fee schedule is set by CMS, it is also subject to additional CMS rules and requirements, including a CMS payment policy termed “Multiple Procedure Payment Reduction (MPPR).” Under MPPR rules, Medicare will pay a provider who performs more than one service on the same day, the full amount for the first unit of service only, and a reduced fee for subsequent services.

• In late 2023, Optum began to apply the MPPR cuts to massage therapy services. In addition to the MPPR cuts, it’s possible that other payment changes also occurred as a result of CMS fee schedule modifications, causing therapists to experience more than one reduction.

• Optum has heard concerns from individual massage therapists as well as AMTA; in February, Optum requested additional guidance from CMS on this policy and how it’s applied to massage therapy. At this time, we are not aware of a response from the VA.

• AMTA also remains in contact with Rep. Pappas’ office, who is also waiting on a response from the VA.

• We encourage massage therapists to review the Optum 2024 provider manual, which includes additional information on claims, submission, coverage, and services. 

Lastly, the current budget in Congress for federal government funding, includes a provision that decreases the amount of 2024 fee reductions to the CMS therapy codes as of March 9. In short, the fee schedules for massage therapy will be slightly higher after March 9, and will remain in effect for the remainder of the fiscal year.

While the budget doesn’t address the MPPR issue, we think it is important for massage therapists to understand that this latest congressional action should result in a minor increase in massage therapy reimbursement.

We hope this status update helps provide some answers to massage therapists on how these cuts occurred in the first place. We are continuing to explore additional options for reimbursement relief and will share new information as we can.