Personal Injury Protection (PIP) Payments for “Physical Therapy Modalities & Services” Are Not Reimbursable When Rendered by a Massage Therapist in Florida

massage therapy and pip

massage therapy and pipBy: Zach Simpson

You may not be aware that the Third DCA ruled earlier this year that “Physical Therapy Modalities & Services” such as electrical muscle stimulation, ultrasound, heat, ice, and traction are not reimbursable under PIP when rendered by a massage therapist in any practice setting. Pointing in part to a law that took effect January 1, 2013 an appeals court sided with Geico General Insurance Co. in a dispute about paying for physical-therapy services provided by massage therapists to auto-accident victims.

Case Details

The Miami-Dade County case involved bills for three patients sent by Beacon Healthcare Center, Inc., under the state’s personal injury protection, or PIP, insurance system.

Physical therapy and physical therapy modalities (i.e. electrical muscle stimulation, ultrasound, heat, ice, and traction) were prescribed for auto accident patients by Beacon’s treating physician and medical director which were performed by massage therapists rather than physical therapists. Neither a licensed physician nor a physical therapist directly supervised the care performed by the massage therapists. However, when Beacon billed GEICO they noted that the supervising physician, and not the massage therapists, provided treatment.  The billing statements also indicated that the massage therapists performed physical therapy modalities under the direct supervision of the medical director, whose only responsibility was to review patient files monthly. Geico General Insurance Company denied payment, which led to Beacon filing a suit in Circuit Court.Continue reading

How Many Lobbyists Does It Take to Write A Statute ?

By: David W. Hirshfeld, Esq.

When the text of the new PIP law became public, our jaws went slack.  The new law imposed incongruous effective dates that would seemingly put many providers out of the PIP business for six months.  How could the insurance industry’s best and brightest have screwed this up?

The new law requires providers to be licensed as “clinics” in order to receive PIP payments, unless an exclusion to that licensing requirement applies.  The incongruity arises because the provision requiring licensure seems to become effective July 1, 2012; but the provision creating the exclusions from that licensure requirement do not seem to become effective until January 1, 2013.  Many providers are rightly concerned that they must either: become licensed as a clinic in order to receive PIP payments, or stop treating PIP patients from July 1, 2012 through January 1, 2013 when an appropriate exclusion will exist.

Thank goodness for Stuart Williams, AHCA’s General Counsel.  In his May 8, 2012 memorandum, Mr. Williams artfully reasons that the statute could and should be interpreted so that both the licensure requirement and its applicable exclusions become effective January 1, 2013.  Now most providers can continue to treat PIP patients without interruption.  Whew!!!

We hope and expect that Florida’s Office of Insurance Regulation will adopt Mr. Williams’ reasoning and educate the PIP insurers.