General Information

OUTPATIENT REFERRAL FORM

Introduction

Manchester-Bedford Myoskeletal LLC provides pain management services by facilitating the correction of musculoskeletal and neuromuscular compensation patterns and dysfunction using modern osteopathic manual techniques (OMT), including soft tissue manipulation, joint mobilization, graded exposure stretching, and other specialized manual and corrective exercise therapy techniques. We use standard osteopathic and orthopedic testing, muscle pattern testing, and various functional movement assessments along with functional muscle activation, retraining, and strengthening for appropriate patients.

For an in-depth discussion on the application of Myoskeletal Alignment to advance patient care as practiced at Manchester-Bedford Myoskeletal LLC , please see this page.

Contact

To speak with the clinic manager/Myoskeletal Therapist, please call (603) 622-1112.

Please Note

Patients are expected to be active participants in their recovery/rehabilitation. Patients who prefer standard western style relaxation massage are generally referred out unless it is called for as part of an ongoing maintenance program for chronic conditions.

Regrettably, no elevator or stair-lift is available for non-ambulatory patients and we are located on the second floor of our building.

Of Interest

Services are provided to individuals who self-refer and by those seen by physician referral. As licensed massage therapists are unable to diagnose any medical condition, we ask referring physicians to provide a diagnosis ICD code and script (if number or frequency of visits is desired) in their referrals. Also, known contraindications, relevant notes, tests results, and radiology imaging and reports are requested. Manchester-Bedford Myoskeletal LLC physician referral form here.

Referrals and any further information may be sent to us
via HIPAA-compliant fax at (888) 965-6870

Part C Medicare Advantage (MA) Plans

Doctor’s referral for massage therapy is required for beneficiaries seeking to use their MA plan’s medical massage benefit for illness or specific musculoskeletal injury. Hover over this statement to read a bullet point or click this link to view the entire letter from the Centers for Medicare & Medicaid Services 2018 letter, pg. 3, para. “Medically-Approved Non-Opioid Pain Management” for the reinterpretation of “Primarily Health Related” for Supplemental Benefits.

How to Make a Referral

Please note: We do not take referrals by phone.

MBM Physician Referral form

1. Fax the referral form to (888) 965-6870.
2. If you’re using your own outpatient referral form, please ensure it contains the following information:
   • Patient’s full name (including maiden name, if known)
   • Date of birth, social security number, or medical record number
   • Current address
   • Current phone number
   • Current insurance information
   • Special needs requirements (preferred day of week for appointment, etc.)
   • Medical history (associated medical conditions, current and ongoing treatments, diagnostic imaging, medications, etc.)
   • Presenting symptoms/diagnosis/ICD 10 codes, and duration
   • Physical findings

Once your request is received, we will call the patient to schedule an appointment. If we are unable to reach the patient within 7 business days, we will send back the referral. Once we schedule an appointment, we will notify your office of the patient’s appointment date and time.

Please note: Response times may vary depending on the urgency of your request and the need to communicate with the patient for scheduling purposes.

Insurance

Manchester-Bedford Myoskeletal LLC is a credentialed in-network provider for the Veteran’s Administration, proudly serving our nations VA physician-referred vets. We are an out-of-network provider with commercial insurances. We cannot send claims to managed care organizations (HMO’s) or government directed insurances, including Medicare, Medicaid, MediGap, or Medicare Supplement plans, or Medicare Advantage HMO plans.

Regretfully, New Hampshire private health insurance companies currently do not credential or contract with our provider type. We therefore file claims for patients with out-of-network benefits and the patient remains responsible for payment at time of service. In most cases, reimbursement from an insurance company will be sent directly to the patient, not to us.

NPI & CAQH Provider ID available to relevant organizations on request

Armed Forces Veteran Patients

The Veteran’s Administration has published several papers, articles, and studies on data pertaining to wounded and injured service men and women returning for a list of medical conditions. The largest population by far, according to the data, is musculoskeletal injury, or what the military calls “MSIs”. Over half of injured vets report these types of injuries. However, no government operated health insurance program currently covers massage therapy or structural integration in their policies.

Manchester-Bedford Myoskeletal LLC management feels that an array of musculoskeletal injuries can be helped and even resolved using the soft tissue techniques employed here. We urge you to read through the Veterans and Insurance pages of our website, and refer your active, retired, and other qualifying veterans to us for assessment, evaluation and/or treatment.

Management

Manchester-Bedford Myoskeletal LLC is owned and operated by Mr. Joel Kouyoumjian, a massage therapist licensed to practice in New Hampshire and New York, and holds a graduate degree of Master Myoskeletal Therapist from the Freedom From Pain Institute.

Mr. Kouyoumjian specializes in assessing and mobilization of intrinsic and extrinsic muscles, fascia, and joints of the musculoskeletal system and troubleshooting causes of muscular dysfunction using appropriate assessment guidelines, Myoskeletal Alignment Techniques, and orthopedic testing and massage. He works with most functional musculoskeletal complaints and any diagnosed conditions described in the Learning Shelf and elsewhere in this site.

More about the owner here.

Patients are referred to their physician or other healthcare practitioner:

• For diagnosis and/or diagnostic imaging
• If Myoskeletal therapy is not appropriate for the patient
• When deemed necessary for furthering patient care
• Patient’s symptoms worsen
• If patient plateaus
• When patient is discharged from care

Thank you

We welcome and invite physician inquiries regarding our business, patient assessments, evaluations, and treatments.

Thank you for your referral.