The VA Standard Episode of Care (SEOC) for Massage Referrals

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 massage therapy).

Veterans are referred to practices like Zeel with a specific SEOC that determines their course of care. Many SEOC details, including the referral duration and the number of authorized treatments, are included in the referral document, which you can find for every Veteran you treat in the Zeel Provider App. Zeel has organized its massage protocols to align with the goals and policies outlined in the VHA’s Massage Therapy SEOCs. 

Initial Care & Continuation Care SEOCs

The VHA has two available SEOCs for which a Veteran may be referred to Zeel

• Initial Care (SEOC #1.12.1)

• Continuation Care (SEOC #1.13.1)

Here’s how each of the two massage therapy SEOCs work (and how they differ):

Initial Care SEOC

• 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

• Any subsequent massage therapy referral with be under the Continuing 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

The SEOCs have the following in common:

• A course of treatment under either SEOC consists of 12 treatments unless otherwise specified in the referral documentation (though extremely rare).

• The first session shall always be 60 minutes in duration and will consist of a patient evaluation, manual therapy, and education.

• All subsequent sessions for the referral shall be 30 minutes unless the provider submits clinical rationale for extending to 60 minutes

• All sessions may include evaluation, manual therapy, adjunctive modalities, therapeutic exercises, stretching, and patient self-care education.

• Patient and provider should set out on every referral with functional goals in mind to support a positive outcome for the patient. A successful course of massage therapy treatment may include any of the following functional improvements:

  • Durable improvement in the condition being treated

  • Clinically meaningful improvement on validated outcome scales, such as the Global Pain Scale (GPS) or Defense and Veterans Pain Rating Scale (DVPRS)

  • Return to work

  • Documented improvement in activities of daily living

  • Documented decrease in need for medications

  • Documented decrease in need for other interventions for the condition

Treatment and the “8 Minute Rule”

Manual Therapy is a timed treatment code for billing under VHA guidelines. This means that in order to bill 30 or 60 minute sessions, the therapist must deliver at least 23 (for a 30 minute session) or 53 (for a 60 minute session) minutes of manual therapy. These details are summarized in this table:

Under the VHA SEOC’s, the following activities may be included as manual therapy time in determining how many units are billable:

• Hands-on manual therapy including manual therapy, adjunctive modalities, and therapeutic exercises.

• Evaluation including collection instruments such as the GPS and DVPRS (used by ZPMS) and hands-on evaluation by the therapist

Patient Education

Patient self-care education may also be delivered verbally in the course of the above activities. This is an important component of a whole-health approach to treating each patient, allowing them to continue their progress between appointments via self-management of their condition. Relevant topics for massage therapy referrals may include proper rest and hydration, passive stretching techniques, breathing exercises, postural corrections, and more.

Learn more about Zeel’s clinical patient education protocol in this PDF.

What is Not Included in the SEOC

The following may not be included as manual therapy time when determining the number of billable units:

• Equipment setup and breakdown

• Hygiene activities

• Clinical documentation