Get the free Medical Massage Claim Form - Choices

MEDICAL MASSAGE THERAPY CLAIM FORM To be completed by Patient or Massage Therapist: HEALTH PLAN ID PATIENT NAME PATIENT DATE OF BIRTH MEDICAL SYMPTOMS REQUIRING TREATMENT PROCEDURE CODE 97124 97124

How to fill out medical massage claim form

How to fill out a medical massage claim form?

1. Start by carefully reading the instructions provided on the form. Make sure you understand the purpose and requirements of the form before you begin filling it out.
2. Provide your personal information accurately. This usually includes your full name, contact details, address, and insurance information. Double-check for any spelling errors or missing information.
3. Indicate the date of the massage session or sessions for which you are submitting the claim. Be specific about the duration and number of sessions.
4. Describe the reason for receiving the medical massage. Provide any relevant medical diagnosis or condition that necessitated the treatment.
5. Include the name and credentials of the massage therapist who performed the treatment. If the therapist is associated with a clinic or facility, include that information as well.
6. Document the cost of the massage session or sessions. This could include the therapist's fee, any additional charges, or the total amount paid. Attach any supporting documents, such as receipts or invoices, if required.
7. If you have insurance coverage for medical massage, indicate your policy details and attach any necessary documentation, like a referral from a healthcare provider or pre-authorization form.
8. Review the completed form to ensure accuracy and completeness. Make sure all required fields are filled out properly and that you haven't missed any supporting documents.
9. Sign and date the form, certifying that the information provided is true and accurate to the best of your knowledge.
10. Keep a copy of the completed form and any supporting documents for your records.

Who needs a medical massage claim form?

1. Individuals who have received medical massages and are seeking reimbursement through their insurance company or employer-sponsored benefit plans.
2. People who have insurance coverage for medical massages and want to submit a claim to their insurance provider.
3. Individuals who need to document their medical massage expenses for tax purposes or other reimbursement purposes.

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