Therapists fight Medicare exclusion

A coalition of health-care providers, including massage therapists, is stepping up efforts to overturn a ruling limiting federal reimbursement for prescribed therapy.

The Coalition to Preserve Patient Access to Physical Medicine and Rehabilitation Service—a coalition of 23 medical organizations, including the American Medical Massage Association (AMMA)—is working to foster public support and coax Congress into reversing a controversial Centers for Medicare and Medicaid Services (CMS) ruling.

In 2004 CMS decided to limit reimbursement to physicians who bill Medicare for therapy services performed by other than physical and occupational therapists and speech pathologists—effectively cutting off massage therapists, vision specialists, athletic trainers and exercise physiologists. The rule went into effect in July 2005.

"We as a coalition think that the ruling is unfair because massage therapists perform a very vital service to patients," said Marie Ruberto, AMMA’s managing director. "And for Medicare to exclude massage therapists and other qualified therapists, we feel that we need to make a stand on it."

CMS claims that the change simply corrects and clarifies rules pertaining to Medicare in the Balanced Budget Act of 1997.

But critics say CMS is defying the wishes of Congress and limits Medicare patients’ access to quality health care. Moreover, since insurance companies routinely follow Medicare’s lead—Blue Cross Blue Shield in Iowa and South Dakota have already followed suit in this case—the rule could potentially limit health care for privately insured patients.

The Dallas-based National Athletic Trainers’ Association (NATA) has led the fight against the rule, and filed a lawsuit arguing that CMS misinterpreted the law and that Congress intended to allow physicians, not the federal government, to determine who can best treat their patients. A federal court ruled against NATA, but the association is appealing that decision.

“Suddenly after six years [CMS] decided to reverse this with no reports or any reason why except for the fact that they have pointed back to the law and said, ‘Sorry, we’ve been misinterpreting the law and we’re now going to get around to changing it,’” said Cate Brennan Lisak, NATA’s external-affairs director. “We in the coalition disagree with CMS’s interpretation of the statute.”

It’s unclear how many massage therapists the rule change affects.

The Lymphedema Stakeholders Political Action Committee, which opposes the CMS rule, estimates that of 4,400 trained lymphedema therapists, 34 percent are massage therapists or nurses.

“Medicare is doing this from absolutely a position of lack of knowledge,” said Charlotte Versagi, a massage therapist and lymphedema expert, and a columnist for MASSAGE Magazine. “Medicare doesn’t understand that the training for lymphedema is at a very high medical level, and that lymphedema therapy can be competently done by a massage therapist who has had good, solid medical training.”

— Laurel Chesky