Scope of practice for LMTs in PA

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Scope of practice for LMTs in PA

Postby ladyships on Mon Mar 05, 2012 12:45 pm

So, one of my employers just informed me that LMTs are not permitted to show clients any stretches in Pennsylvania…I had gotten my training in 2011 at a school in Massachusetts, where we had been taught that we were allowed to show clients how to stretch, so long as we did not “prescribe” anything like a recommended frequency/duration/regime or guarantee that doing such stretches would provide relief. (You had to phrase it something like, “Well, many people with similar problems find that doing this helps them manage…”)

So...I decided to read PA’s MT law a bit more carefully & see what it had to say about scope of practice:

§ 20.41. Scope of practice.

(a) Massage therapists apply a system of structured touch, pressure, movement, holding and treatment of the soft tissue manifestations of the human body in which the primary intent is to enhance the health and well-being of the client. Massage therapy includes:

(1) The external application of water, heat, cold, lubricants and other topical preparations.

(2) Lymphatic techniques.

(3) Myofascial release techniques.

(4) The use of electro-mechanical devices which mimic or enhance the action of the massage techniques.

(b) Massage therapy practice does not include:

(1) The diagnosis or treatment of impairment, illness, disease or disability.

(2) Medical procedures.

(3) Chiropractic manipulation—adjustment.

(4) Physical therapy mobilization—manual therapy.

(5) Therapeutic exercise.

(6) Ordering or prescribing drugs or treatments for which a license to practice medicine, osteopathic medicine, nursing, podiatry, optometry, chiropractic, physical therapy, occupational therapy, or other healing art is required.

(7) The application of high velocity/low amplitude force further defined as thrust techniques directed toward joint surfaces.

(8) The use of equipment or devices that require a prescription (for example, ultrasound, diathermy or electrical neuromuscular stimulation).

(c) Licensure under the act may not be construed as requiring new or additional third-party reimbursement or otherwise mandating coverage under 75 Pa.C.S. Chapter 17 (relating to financial responsibility) or the Workers’ Compensation Act (77 P. S. § § 1—1041.4 and 2501—2506).


So, I’m guessing §20.41(b)(5) is what my employer is referring to, right? Seems pretty vague to me. Anybody have any feedback on this?

I really like to think that educating clients on how to be taking better care of themselves is part of what I do—I understand I should refer to more qualified professionals when appropriate...but when somebody’s getting tension headaches every night because they work at a desk from 9 to 5 & it hasn’t occurred to them that getting up & moving periodically might help prevent those headaches in the future?

It just feels like I’m running a racket if I’m not allowed to point out how they might take some simple preventative steps in the future, so they’re not completely dependent on me/MT to manage their chronic pain or discomfort. (Some clients actually ask me for advice on what they could be doing differently & it really takes a lot out of me to be limited to biting my tongue & saying, “Regular massage…”—as though that’s the only answer.)

I could live with not being able to say anything if I were allowed to give them xeroxes from books or articles or something…anything…to give them some sort of guidance regarding what direction to look into, if they really DO want to become more actively involved in taking greater responsibility for their own health/quality of life. All of my teachers at school, & all the bodywork books I love reinforced this philosophy during my training. & I’m just sort of at a loss for how to do that without being able to tell my clients anything.

Some guidance from more experienced practitioners in Pennsylvania would be greatly appreciated...
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Re: Scope of practice for LMTs in PA

Postby pueppi on Mon Mar 05, 2012 4:49 pm

ladyships wrote:So, one of my employers just informed me that LMTs are not permitted to show clients any stretches in Pennsylvania…I had gotten my training in 2011 at a school in Massachusetts, where we had been taught that we were allowed to show clients how to stretch, so long as we did not “prescribe” anything like a recommended frequency/duration/regime or guarantee that doing such stretches would provide relief. (You had to phrase it something like, “Well, many people with similar problems find that doing this helps them manage…”)

So...I decided to read PA’s MT law a bit more carefully & see what it had to say about scope of practice:

§ 20.41. Scope of practice.


(b) Massage therapy practice does not include:


(5) Therapeutic exercise.


<snip>

(c) Licensure under the act may not be construed as requiring new or additional third-party reimbursement or otherwise mandating coverage under 75 Pa.C.S. Chapter 17 (relating to financial responsibility) or the Workers’ Compensation Act (77 P. S. § § 1—1041.4 and 2501—2506).


So, I’m guessing §20.41(b)(5) is what my employer is referring to, right? Seems pretty vague to me.



Under the CPT codes:

"CPT Code 97110
Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility"


It appears that the language within the scope of practice, is specific enough that it is most likely referring to the above for coding and billing. And, vague enough, that it doesn't say anything about showing the client a stretching move to do at home, in less than a 15 min. time frame while in your office. But, I am not from PA, nor do I know anything about their laws. So, you be the judge... ;)
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Re: Scope of practice for LMTs in PA

Postby JaeMarie on Mon Mar 05, 2012 9:05 pm

I'm in Illinois, so take this for what it's worth...

My understanding from what I was taught in school is that massage therapists have to be careful not to cross the line into the scope of practice for PT's etc. So, while we can make suggestions like "you may want to try a _____ stretch - it looks like this..." you can't say "you need to do a _____ stretch. [instructs/walks client through stretch] You need to do this X times a day for X duration."

The difference would be offering a suggestion which leaves the decision to follow through up to the client and in their own space on their terms, VS instructing/prescribing/telling the client to perform a specific action in a specific manner for a determined period of time or number of actions, or actually having them perform these actions in the office under the therapists supervision.

If that particular employer decides that they don't want any of their employees offering stretches to the clients for fear of getting in trouble, then I guess the choices would be to play along, leave, or best yet - contact the licensing board and try to get clarification so you can protect yourself and/or potentially educate your employer.
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Re: Scope of practice for LMTs in PA

Postby squash_blsm on Tue Mar 06, 2012 4:43 am

The laws were specifically written due to pressure from physical therapists to exclude the use of billing/cpt codes
97140 manual therapy and
97110 therapeutic exercises
and to exclude MT's from any manual manipulation that is under scope of physical therapy and chiropractic

There is no exclusion for billing for these by Physical Therapists or Chiropractors when the MT is working under their direction and THEY are the provider.

Someone at least got Myofascial Release and Lymphatic Drainage stuck in there as within scope of practice (whew!).

So technically, if you are prescribing stretching as part of your treatment plan you are crossing the line.
I know plenty of MT's and Massage clinics that suggest stretches or give handouts about stretching.
I doubt that the massage police will be shutting them down. But the minute a PT or DC feels threatened by any loss of business they could certainly file a complaint. It probably depends on how the MT handles it.
I used to do stretching as part of the session when I worked for a DC. I do NOT typically do that now other than as a release technique every so often (a la James Waslaski training).
MT's may not diagnose ANY condition - even when it is a soft tissue condition such as muscle/tendon sprain/strain, rotator cuff injury, plantar fasciitis, blah, blah, blah - conditions which we typically treat.
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Re: Scope of practice for LMTs in PA

Postby ladyships on Fri Apr 06, 2012 3:42 am

I just sent an email to the PA State Board asking them for clarification. I’ll post whatever they end up saying in their reply, once I get it…

A related question: If a client has self-diagnosed themselves with carpal tunnel syndrome (seems to be a catch-all term for “I have wrist pain/discomfort”), & I have them do Phalen’s test & they experience no reproduction of symptoms &/or compression of the median nerve, am I allowed to tell them that it’s doubtful they actually have carpal tunnel syndrome, or should I just keep quiet & stick to just noting the results of the test in my SOAP chart for the session?
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Re: Scope of practice for LMTs in PA

Postby squash_blsm on Fri Apr 06, 2012 4:53 am

ladyships wrote:I just sent an email to the PA State Board asking them for clarification. I’ll post whatever they end up saying in their reply, once I get it…

A related question: If a client has self-diagnosed themselves with carpal tunnel syndrome (seems to be a catch-all term for “I have wrist pain/discomfort”), & I have them do Phalen’s test & they experience no reproduction of symptoms &/or compression of the median nerve, am I allowed to tell them that it’s doubtful they actually have carpal tunnel syndrome, or should I just keep quiet & stick to just noting the results of the test in my SOAP chart for the session?


An MT cannot diagnose ANY condition.

You can (if you are careful) describe the movements as a self-test and mention that they need an MD to diagnose.
I will sometimes say - that is consistent with (condition) but you will need to consult a specialist for a correct diagnosis and treatment suggestions. Massage is beneficial for many conditions such as ( fill in the blank).
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