Massage + Physical Therapy Modalities No More:
Third District Court of Appeals Strikes Down Opinion on Massage Therapy in PIP
The Third District Court of appeals in Miami overruled a county court opinion providing PIP reimbursements for physical therapy services rendered by a licensed massage therapist. This ruling was surprising given the plain language of the Florida Personal Injury Protection statute. This opinion is unfortunately the going to re-shape PIP reimbursements for massage therapists performing physical therapy modalities unless the other District courts of appeal receive similar cases and issue contradictory rulings. Please read for a more in-depth analysis of the litigation and the background concerning the court’s ruling.
THE PIP STATUTE AND FLORIDA LAW REGARDING MASSAGE THERAPY/PT
The Florida PIP statute, as amended, effective January 1, 2013, excluded massage from the type of health care services that PIP reimburses. The PIP statute as amended also states that, “medical benefits include massage as defined in s. 480.333…, regardless of the person, entity, or licensee providing massage… and a licensed massage therapist… may not be reimbursed for medical benefits under this section). Massage therapists are permitted to use physical therapy “agent” (modalities) “as part of, or incidental to, the lawful practice of their profession as massage therapists.” This language is found in Fla Stat. Section 486.161(1) (2019). Thus, in summary, massage therapists ARE permitted by Florida law to utilize physical therapy modalities as part of, or incidental to their medical practice/services.
FACTS OF THE CASE/TREATMENT
The above-mentioned case involved a physician-owned entity that prescribed physical therapy modalities (hot/cold packs, electric stimulation, etc.) for the patient. The treatment was actually rendered by a massage therapist employed by the physician-owned entity. The physician who referred the patient to therapy was the medical director of the clinic.
Importantly, the physician did not supervise the massage therapist. The massage therapist performed all treatment alone. This played a great part in the district court’s ultimate decision.
The county court in Miami ruled on behalf of the medical provider, reasoning that a health care clinic is eligible to receive PIP benefits for physical therapy treatment performed by an unsupervised massage therapist. However, the Honorable Judge, in that case, wanted further clarification from a higher court. She asked the Third District of Appeals to answer two questions:
- MAY A PERSON LICENSED AS A MASSAGE THERAPIST, BUT NOT LICENSED AS A PHYSICAL THERAPIST, LAWFULLY RENDER PHYSICAL THERAPY MODALITIES ENUMERATED IN SECTION 486.021(11) WHERE SUCH THERAPY IS PART OF OR INCIDENTAL TO THE LAWFUL PRACTICE OF MASSAGE THERAPY?
- MAY A HEALTH CARE CLINIC LICENSED UNDER PART X CHAPTER 400 RECEIVE PIP REIMBURSEMENTS FOR PT SERVICES ENUMERATED IN SECTION 486.021(11) RENDERED BY A LICENSED MASSAGE THERAPIST EMPLOYED BY THE CLINIC THAT IS NOT “MASSAGE” AS DEFINED BY SECTION 480.33(3), FLA. STAT.?
The Third District Court of Appeals did a brief analysis and concluded that a massage therapist can lawfully render physical therapy modalities; in that their license provides for such treatment. A massage therapist is permitted to apply physical therapy modalities whether the therapy is part of or incidental to their practice. However, the Third District disagreed with the trial court Judge concerning Pip reimbursements. The Appellate court concluded that a licensed massage therapist is not eligible to receive PIP reimbursements for physical therapy services. That ruling, in their estimation, is based on the PIP statute, as amended. They read the statute as disallowing any type of PIP reimbursement for non-massage services rendered by a massage therapist. The Third District Court of Appeals also highlighted that the treatment rendered by the massage therapist was performed without any supervision.
LABOVICK LAW GROUP’S COMMENTARY
This author believes that if the massage therapist was supervised by a supervising physical therapist or physician, the analysis would shift towards allowing PIP reimbursements. In our opinion, it came down to who had the “legal authority” to fill out the Health Insurance Claims Form (“” HCFA”). In this case, the massage therapist performed the physical therapy modalities. Despite the same, the HCFA stated that the massage therapist was performing these services under the direct supervision of the referring physician. In reality, this was untrue. In fact, this issue was dropped by the Health Care clinic on appeal. The clinic admitted they mistakenly entered the sign of the clinic’s medical director as a supervisor of all services rendered by the massage therapist.
If the fact changed a bit, and the treating physician directly supervised the services, he would’ve had the authority to fill out the HCFA on his own accord. In turn, the supervisory doctor may have billed and potentially received PIP reimbursement for the services rendered. The main questions out of this opinion will linger:
- If the massage therapist was supervised by a physician and/or physical therapist, would the clinic be eligible for PIP medical benefits?
- Does it matter who supervises the massage therapist in rendering the physical therapy modalities?
HOW DOES THIS CASE CHANGE THE PIP LANDSCAPE?
This case answers the question as to whether a massage therapist is permitted to perform physical therapy modalities without direct supervision…. for now. There’s a very good chance this issue could make it to the Florida Supreme Court down the road if another district disagrees. The result could have changed if the treating physician directly supervised the massage therapist. He could’ve simply billed for the services and appended his name on the HCFA as the individual directly supervising the underlying health care service.
Thus, it follows that a treating physician/PT x massage therapist rendering physical therapy modalities may qualify for PIP reimbursement under the statute. That question wasn’t answered in this case. As mentioned above, the clinic withdrew that argument on appeal. It’s quite a shame that we didn’t get an answer as to whether a supervising physician is eligible for PIP reimbursement for a massage therapist rendering physical therapy modalities. We can only hope that another District Court of appeals is presented with a supervisory doctor situation. That will lead us down the right PIP path for purposes of reimbursement!
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