N O S U R P R I S E S A C T
Good Faith Estimate
In accordance with the no surprises act, we have created this resource as a full disclosure of pricing in our clinic.
If you have selected an elective massage:
Your CPT code is S8990. Our office bills $25.00 per unit.
1 Hour Massage: 4 Units. Total $100.00
Add On Elective Modality (Hot Stones, Cupping et. al): $15.00
100% patient responsibility. Payment due no later than the day of the appointment.
If you have selected a therapeutic massage:
Your CPT code is 97124. Our office bills $50.00 per unit. If Cupping is deemed medically necessary, one unit will be
billed as 97140, and the remaining units as 97124.
Maximum of 4 units per day. (Additional units will be billed as S8990. See above)
97124 and 97140 are billable codes for insurance. Below are the rates we have negotiated with insurance companies
for in network coverage. The difference between our billed amount, and the contracted rate, will be written off. We do
not balance bill for in network plans.
Contracted Rate for 97124 with Regence: $33.50 per unit
Contracted Rate for 97124 with Providence: (Contract Pending)
Contracted Rate for 97124 with Pacific Source: $30.50 per unit
The application of heat or ice, such as hot stones and ice packs, will be billed as 97010, at the rate of $15.00.
Below are the rates we have negotiated with insurance companies for in network coverage. The difference between our billed amount, and the contracted rate, will be written off. We do not balance bill for in network plans.
Contracted Rate for 97010 with Regence: $33.50 per unit
Contracted Rate for 97010 with Providence: (Contract Pending)
Contracted Rate for 97010 with Pacific Source: $30.50 per unit
Cost sharing between you and your insurance company is plan specific. If you would like to know what your
estimated portion is, please request a benefits inquiry via email to aaronhill.lmt@gmail.com. Alternatively, you
may call the member number on the back of your card to inquire.
Our billing staff can work with you to try to obtain reimbursement from the insurance company. If our billing staff is
unable to negotiate payment from your insurance, you will receive our self-pay discount of 50% if paid within 3
business days of the invoice.
In compliance with the No Surprises Act, Massage Spot PDX is required to provide a Good Faith Estimate to uninsured individuals and to individuals who choose to self-pay. You are not required to obtain a Good Faith Estimate. Much of the same information is found above. To receive the Good Faith Estimate provided for you, please
email your request to aaronhill.lmt@gmail.com.
If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing
within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility
gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before
you schedule an item or service. If you do, make sure the healthcare provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill. Make sure to
save a copy or picture of your Good Faith Estimate and the bill.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1-800-985-3059