Insurance Billing

Insurance Companies May No Longer Discriminate Against LMTs for Same Services – It’s the Law!


The provider non-discrimination provision of the Affordable Care Act went into effect on January 1, 2014. Insurance plans issued on or after this date are now prohibited from treating licensed massage therapists differently from other providers when the LMT is treating the same conditions or performing the same services that the insurer would otherwise cover.  There are some long standing commercial, and some private plans to which the new ACA regulations do not apply.After two years of working with Oregon’s Insurance Division in advance of this law going into effect, it appears that the majority of insurers and insurance plans are in some way still violating this law.

Text of the Non-Discrimination Law

  • 2706(a) of Public Health Service Act, created by § 1201 of Patient Protection and Affordable Care Act (“PPACA”)– NON-DISCRIMINATION IN HEALTH CARE.

‘‘(a) PROVIDERS.—A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law. This section shall not require that a group health plan or health insurance issuer contract with any health care provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan, a health insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures. – 42 U.S.C. §300gg-5(a).

Examples of What Might Be a Violation of Section 2706  of the Public Health Service Act as added by the Affordable Care Act 

**Please keep in mind that many of these will only apply to CPT code 97140-manual therapy. The code 97124—massage therapy is often not covered for anyone under a plan and, therefore, is not a violation. However, if a LMT is providing 97140 services and billing 97140 code that the insurance plan covers when provided by a PT, ND, DC, etc., it is a violation of the ACA to not then also cover the same service when provided by a LMT.

  • Not covering massage therapy services at all, even as an out-of-network provider.
  • Applying a $1,000 or other annual cap for services that are identical to those of other providers not subject to this cap.
  • Reimbursement rates for same quality and performance of services done by a licensed massage therapist are substantially different for LMT than for other providers.
  • LMT is in-network with insurer but some plans offered by insurer deny coverage of services by LMT.

What do you do if you think your massage therapy services are being discriminated against? File a complaint with the Insurance Division.