Third DCA Rules “Physical Therapy Services” Are Not Reimbursable Under PIP When Rendered By A Massage Therapist
Feb 28, 2020 in Case Law Updates by bronsteincarmona
By – Erica A. Showell, Esquire
In Geico General Insurance Company v. Beacon Healthcare Center. Inc., as assignee of Ramon Martinez, Angel Carreo and Teresa Landa Del Castillo, the Third District Court of Appeal (“DCA”) of Florida vacated the declaratory judgment entered in favor of Beacon Healthcare Center, Inc. (“Beacon”) and remanded the three consolidated cases with instructions to the trial court to enter judgment in favor of Geico. The trial court certified the following two questions to the Third DCA: 1) May a person who is licensed as a massage therapist, but not licensed as a physical therapist, lawfully render physical therapy modalities enumerated in § 486.021(11) where such therapy is part of or incidental to the lawful practice of massage therapy?; and 2) May a healthcare clinic licensed under Part X Chapter 400 receive Personal Injury Protection (“PIP”) reimbursements for physical therapy services enumerated in § 486.021(11) rendered by a licensed massage therapist employed by the clinic that is not “massage” as defined by § 480.033(3), Fla. Stat.?
The Third DCA concluded that “a person who is licensed as a massage therapist, but not licensed as a physical therapist, lawfully renders physical therapy modalities enumerated in section 486.021(11) where such therapy is part of or incidental to the lawful practice of massage therapy, “ but, they will not be reimbursed by an insurer through PIP benefits. The court reasoned that in 2013, the Florida PIP Statute was amended to exclude massage from the types of health care services that are reimbursable under PIP, and prohibiting massage therapists from receiving PIP reimbursements.
In Geico v. Beacon, the named insureds under Geico’s policy were involved in automobile accidents that triggered PIP benefits when they sought rehabilitation therapies at Beacon. The entitlement to PIP benefits came into question when the insureds presented for initial consultations and were seen by Beacon’s Medical Director and Treating Physician, who prescribed physical therapy modalities, including but not limited to hot/cold packs, electrical stimulation, ultrasound, myofascial release (manual therapy), and traction. The prescribed modalities were rendered at Beacon by a massage therapist, who was not directly supervised by a licensed physical therapist or a medical physician. When Geico was billed for the services rendered, Beacon’s bill (CMS-1500 form) indicated in box 31, (the box reserved for the name of the person who performed or directly supervised the services) the name of the medical director and treating physician, rather than the massage therapist who performed the services, also indicating that the “physical therapy” was under the direct supervision of the medical director/ treating physician.
Having notice that Beacon had erroneously billed for the services rendered, Beacon’s entire claim for PIP benefits was denied. Geico subsequently sued Beacon for submitting claims for charges for physical therapy services that were unlawfully rendered and for operating in violation of the Health Care Clinic Act. During the pendency of that case, Beacon sued Geico for declaratory judgment, on the first certified question presented before the Third DCA, and whether Beacon was operating lawfully with the medical director complying with his professional duties. The Trial Court granted summary judgment and final declaratory judgment to Beacon, concluding that a health care clinic can recover No-Fault PIP benefits for physical therapy services performed by unsupervised massage therapists, but certifying the aforementioned questions of great importance to the Third DCA.
The Third DCA’s review of the certified questions was de novo, giving the Florida PIP Statute its plain and ordinary meaning, finding that the language was clear and unambiguous. Therefore, the PIP statute precludes reimbursements for physical therapy services enumerated in section 486.021(11) rendered by a licensed massage therapist, who is not licensed as a physical therapist, or under direct supervision, when the massage performed is not defined by section 480.033(3).
 Section 480.033(3), Fla. Stat.(2019) “Massage” means the manipulation of the soft tissues of the human body with the hand, foot, arm, or elbow, whether or not such manipulation is aided by hydrotherapy, including colonic irrigation, or thermal therapy; any electrical or mechanical device; or the application to the human body of a chemical or herbal preparation.