Issue link: https://www.massageandbodyworkdigital.com/i/68178
ABMP Definitions Massage Massage, or massage therapy, is a system of structured palpation or movement of the soft tissue of the body. (For simplicity's sake, massage and massage therapy are often used interchangeably to describe more than 250 massage, bodywork, and somatic therapies or modalities.) The massage system may include, but is not limited to, such techniques as stroking, counterstrain, soft-tissue mobilization, and myofascial release. You may have noticed the use of kneading, gliding, percussion, friction, vibration, compression, passive or active stretching within the normal anatomical range of movement; effleurage (either firm or light soothing, stroking movement, without dragging the skin, using either padded parts of fingertips or palms); petrissage (lifting or picking up muscles and rolling the folds of skin); or tapotement (striking with the side of the hand, usually with partly flexed fingers, rhythmic movements with fingers or short rapid movements of sides of the hand). These techniques may be applied with or without the aid of lubricants, salt or herbal preparations, hydromassage, thermal massage, or a massage device that mimics or enhances the actions possible by human hands. The purpose of the practice of massage is to enhance the general health and well-being of the recipient. Massage does not include the diagnosis of a specific pathology, the prescription of drugs or controlled substances, spinal manipulation, or those acts of physical therapy that are outside the scope of massage therapy. Bodywork An outgrowth of massage and other systems, bodywork is defined as various forms of touch therapies that may use manipulation, movement, and/or repatterning to affect structural changes to the body. Somatic Therapies Somatic means "of the body" and is often used to denote a mind-body or whole-body approach, as distinguished from a physiology-only perspective. Specific massage techniques such as craniosacral therapy and neuromuscular therapy target the nervous system, but do not reeducate the system through movement in the way that Feldenkrais or physical therapy do. Proprioceptive techniques also manipulate the nervous system in an effort to alter the soft tissue of muscle, but again, this is not considered neuromuscular reeducation as described by the AMA. MANUAL THERAPY In 1998, the AMA created a new current procedural terminology (CPT) code specifically for physical therapists. Billing practices prior to this had identified individual procedures such as joint mobilization, myofascial release, and muscle energy techniques under separate codes. The new system lumped all of these techniques under a single code (CPT code 97140 for manual therapy) and limited the number of times this code could be billed during a single treatment. The American Academy of Orthopedic Manual Physical Therapy and APTA define manual therapy as "a clinical approach utilizing skilled, specific hands-on techniques, including but not limited to manipulation/ mobilization, used by the physical therapist to diagnose and treat soft tissues and joint structures for the purpose of modulating pain; increasing range of motion; reducing or eliminating soft-tissue inflammation; inducing relaxation; improving contractile and non- contractile tissue repair, extensibility, and/or stability; facilitating movement; and improving function."8 These organizations consider the following techniques to be manual therapy: mobilization/manipulation, muscle energy techniques, strain- soft-tissue mobilization within their definition. That's massage, right? Well, not exactly. Typically, insurance companies assign it a separate CPT code (97124 for massage therapists). It differentiates services provided by a physical therapist (97140 for manual therapy) from "the manipulation of soft tissue for therapeutic purposes" delivered by a massage therapist. Many massage therapists saw an opportunity to increase their reimbursement by using the 97140 code for manual therapy, as it was assigned a higher dollar amount. After all, massage therapy is manual therapy. Herein lies the seed of the controversy: massage therapists use billing codes intended for physical therapists. This has fueled the turf wars between physical therapists and massage therapists. This controversy grows as other health professionals, such as chiropractors, employ massage therapists and bill multiple codes not clearly identified as appropriate. EXCLUSIONS AND EXEMPTIONS Once issues of terminology are clear, legislators must tackle the issue of exclusions and exemptions. This identifies disciplines similar to massage, but that not be regulated by massage law. Typical exclusions and exemptions include reflexology, structural integration, movement reeducation, Asian bodywork, and energetic modalities such as reiki. Many practitioners, organizations, and associations lobby for exclusion or exemption in an effort to keep themselves or their members unregulated. There is some consistency from state to state with regard to exempt modalities, but legislators must consider the prevalence of particular disciplines, public safety concerns, enforcement practices and resources, and budgetary connect with your colleagues on massageprofessionals.com 63