What is the VA “Standard Episode of Care” (SEOC) for Massage Therapy?

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The Veterans Health Administration (VHA) provides protocol guidelines for every medical service delivered to Veterans, either by VA-affiliated practitioners or Community Care providers like Zeel. This guidance is referred to as a Standard Episode of Care, or SEOC.

The SEOC outlines the intent and scope of treatment including treatment goals, number and frequency of treatments, and allowed CPT codes (which represent specific interventions, such as manual therapy, evaluations, or self-care education). Zeel has organized its own massage protocols to align with the goals and policies outlined in the VHA’s Massage Therapy SEOCs.

Initial Care vs. Continuation Care

The VHA has two available SEOCs* for which a Veteran may be referred to Zeel for medical massage. Here’s how each of the two massage SEOCs work (and how they differ):

Initial Care SEOC (SEOC #1.12.1)

  • A Veteran’s first massage therapy referral will be Initial Care
  • Initial Care referrals expire 90 days from the first treatment date
  • This translates to a treatment cadence of roughly 1 treatment per week

Continuation Care SEOC (SEOC #1.12.1)

  • Any subsequent massage therapy referral will be under the Continuation Care SEOC
  • Continuation Care referrals expire 180 days from the first treatment date
  • This translates to a treatment cadence of roughly 1 treatment every two weeks

Zeel’s goal is to deliver the number of treatments recommended by the VA in the referral authorization to every veteran. Regular treatment not only provides the best outcome for your condition, but ensures that you receive all the care you are entitled to under your VA benefits and your physician’s recommendation.

What’s Included in the SEOC for Medical Massage?

For both SEOCs (Initial or Continuation Care) the course of treatment includes the following, as dictated by the VHA:

  • Every referral consists of a course of 12 treatments unless otherwise specified. NOTE: Treatments do not roll over if they aren’t delivered by the referral expiration date, so it’s important to take advantage of every treatment available to you in a referral!
  • The first session in a referral is always 60 minutes in duration and includes a 30-minute evaluation in addition to hands-on therapy.
  • Subsequent sessions are 30 minutes by default, but the provider can recommend extending to 60 minutes, if clinically warranted.
  • Every appointment includes at least a brief evaluation to monitor your condition and recovery progress. These evaluations utilize VA-preferred systems such as the Global Pain Scale (GPS) and Defense and Veterans Pain Rating Scale (DVPRS).
  • Sessions may also include education on self-care of your condition, as well as adjunctive modalities like therapeutic exercises or stretching.

Understanding Your Explanation of Benefits

Like any other medical appointment, procedure, or prescription, you will receive an Explanation of Benefits, or EOB, listing the components of your massage appointment, as they have been billed to the VA. These components are represented by CPT codes, which are numeric shorthand for reporting medical services in healthcare communication and billing.

For your Zeel massage therapy appointments, you may see one or both of the following:

  • Therapeutic Massage Therapy (97124): This explicitly denotes your hands-on massage treatment, but it also includes the intake and evaluation procedures accompanying the massage.
  • Education and Training for Patient Self-Management (98960): This represents information and guidance provided by the therapist outside the scope of evaluation and massage, to help you manage your condition between appointments.

Both CPT codes are recommended components of the VA’s SEOCs for massage therapy. While “Education and Training” is documented as a separate CPT code, it may be integrated throughout an appointment as your therapist works closely with you to holistically identify areas for independent improvement.

As with any EOB, you will see Zeel’s national billing rate per CPT alongside the actual payment remitted to Zeel by the VA under its standard claims processing rules for your geography.

What is Patient Education?

This is an important component of the VHA’s whole-health approach to patient care, helping you continue your progress between appointments. Relevant topics your therapist may discuss with you include passive stretching techniques, mobility training, breathing exercises, postural corrections, personalized exercise recommendations, and more. The purpose is to give you additional tools to actively participate in your recovery and thrive beyond the limited time of each appointment.

If you received self-care education and/or guidance on therapeutic exercise, your EOB may include the CPT code 98960. This is not an additional fee, but rather is part of the scope of the medical massage therapy SEOC.

Goal-Setting and Tracking Progress

For every referral (even if you’ve already completed one or more), you and your provider should set functional goals for your course of treatment. This will help you and the therapist track your progress toward recovery, as well as provide essential information to the VHA about the efficacy of massage and the potential need for continuing treatment.

A successful course of massage therapy may include any of the following functional improvements:

  • Meaningful improvement on outcome scales, such as the Global Pain Scale (GPS) or Defense and Veterans Pain Rating Scale (DVPRS)
  • Documented decrease in the need for pain medications (prescription or OTC)
  • Returning to work after a disability
  • Durable improvement in the condition being treated
  • Documented improvement in activities of daily living
  • Documented decrease in need for other interventions for the condition

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*NOTE: The “Initial Care” and “Continuation Care” SEOCs replaced the previous SEOCs for “Acute Care” and “Chronic Care” on February 23rd, 2024.