Understanding Insurance Billing For Massages: A Comprehensive Guide

Massage therapy is not always covered by insurance, and it is considered an alternative treatment. However, it can be covered in specific situations, such as when it is deemed medically necessary or when it fits the criteria of coverage provided by the insurance company. The best way to find out if massage therapy will be covered by insurance is to verify coverage with the insurer directly and ask them questions to understand their policy. For example, asking about the conditions to qualify for reimbursement, if there is a deductible, or if there is a maximum amount payable per visit or policy term.

Massage therapy is usually covered by insurance if it is deemed medically necessary

Some insurance companies that cover medically prescribed massages include BlueCross/Blue Shield, United Health Care, Cigna, and Aetna. However, it is important to verify with your specific insurance provider whether massage therapy is covered.

To increase the chances of insurance coverage for massage therapy, it is recommended to obtain a referral or prescription from a primary care physician. A prescription or referral from a physician is crucial for reimbursement since massage therapists are typically not licensed to diagnose medical conditions. With a referral from a doctor, the massage therapist can include the ICD-10 diagnostic code and referring provider on the CMS-1500 form, improving the likelihood of reimbursement.

Additionally, it is essential to understand the specific coverage requirements of your insurance company. They may require pre-authorization, which means submitting the prescription and relevant medical information for approval before receiving massage therapy.

If massage therapy is not covered by your insurance, there are alternative options to consider. Health Savings Accounts (HSA), Flexible Spending Accounts (FSA), and Health Reimbursement Arrangements (HRA) can be utilized to cover massage costs if they qualify as medically necessary. Discounted massage therapy is also offered by some massage franchises through monthly memberships. Furthermore, local massage therapy schools may provide massages at discounted rates, allowing students to gain real-life training under the supervision of professional massage therapists.

A prescription or referral from a doctor is often required for insurance coverage

Massage therapy is increasingly recognised as an important component of pain-relief and treatment plans for patients. However, it is often considered an alternative treatment, and insurance companies may not always cover it. A prescription or referral from a doctor is typically required for insurance coverage, and there are several reasons for this. Firstly, massage therapists are not licensed to diagnose medical conditions, so a doctor's prescription or referral is necessary to confirm the medical necessity of the treatment. Secondly, a prescription allows the massage therapist to follow the specific instructions provided by the doctor, as they are not authorised to deviate from the prescribed treatment. For example, if the prescription specifies massage therapy for “muscle pain” in the left ankle, the therapist cannot begin treating another area, such as the lower back, without an updated prescription.

To obtain a prescription or referral for massage therapy, patients should clearly communicate their symptoms and requests to their doctor. For instance, a patient with low back pain could explain their symptoms and express their interest in trying massage therapy based on its benefits for acute pain management. Doctors are often open to prescribing massage therapy as it is a safe, non-addictive, and effective treatment option. When requesting a prescription, it is advisable to ask for one that does not specify the frequency and number of massages, as this allows for greater flexibility in the treatment plan.

Once a patient has a prescription or referral, they can proceed to find a massage therapist who accepts their insurance. It is important to verify coverage with the insurance company beforehand, as policies and requirements may vary. Some insurance companies may require pre-authorisation or have specific criteria for coverage. Additionally, it is essential to confirm that the massage therapist is licensed and qualified to provide the prescribed treatment.

It is worth noting that even with a doctor's prescription or referral, insurance coverage for massage therapy is not guaranteed. In such cases, patients may need to explore alternative options, such as using health savings accounts (HSAs), flexible spending accounts (FSAs), or health reimbursement arrangements (HRAs) to cover the costs of massage therapy.

Massage therapists cannot diagnose patients, so a prescription must specify the treatment area

Massage therapy is an increasingly popular treatment for pain relief, with doctors and patients turning to it as an alternative to opioid medications. However, it is often considered an elective treatment by insurance companies, and so visits to a massage therapist are not always covered by medical insurance.

Even when massage therapy is covered, there may be limitations. For example, some plans require that massage be performed by a physical therapist or within a physician's office. Additionally, there may be a maximum amount payable per policy term or visit, and there may be time limits per body region.

To increase the chances of insurance coverage, it is recommended that patients obtain a referral or prescription from their doctor. This is because massage therapists are not licensed to diagnose medical conditions, and so a prescription from a doctor is necessary for reimbursement. The prescription must include the treatment start date, number of visits, frequency of sessions, and diagnosis codes referencing the patient's injury or condition. The diagnosis codes are especially important, as they are required to claim the massage therapy sessions with the insurance company.

It is also important to note that not all massage therapists are able to directly bill insurance companies, so patients may have to claim the therapy themselves.

Insurance companies may have different definitions of massage therapy and reasons for receiving it

Some insurance companies may only cover massage therapy if it is deemed medically necessary or if it fits the criteria of coverage provided by the insurer. For example, if the massage is considered rehabilitative or is part of a "habilitative or habilitation" treatment plan, it may be covered by insurance. Additionally, some insurance companies may require a referral or prescription from a doctor for massage therapy to be covered.

It's important to note that even if massage therapy is covered by insurance, there may still be limitations or restrictions. For example, there may be a limit on the number of massages covered or the duration of each massage. There may also be specific requirements for the type of massage or the credentials of the massage therapist.

To understand their coverage, individuals should contact their insurance company directly and ask questions about the conditions for reimbursement, out-of-pocket costs, maximum amounts payable, and any other relevant details. By doing so, they can ensure they have a clear understanding of their coverage and can make informed decisions about their massage therapy treatments.

Massage therapy may be covered under the Affordable Care Act's 10 essential health benefits

Massage therapy is considered a part of complementary and alternative medicines (CAM). CAM can be used to complement standard medical treatment by doctors when addressing certain medical conditions and situations. According to the Centers for Disease Control and Prevention (CDC), 23.5% of American adults spent money on complementary health measures at least once in 2012.

The Affordable Care Act (ACA) requires that all individual and small group health plans cover important health benefits like maternity, mental health, preventive, and pediatric dental care. These essential health benefits fall into 10 categories:

• Ambulatory patient services (outpatient services): Massage therapy can be considered a form of ambulatory patient service, as it is often used to address specific medical conditions and ailments.
• Maternity and newborn care: Massage therapy may be beneficial for pregnant women and new mothers, providing relaxation and relief from muscle tension and pain.
• Mental health and substance use disorder services: Massage therapy can be an effective treatment for stress, anxiety, and substance use disorders, helping to promote relaxation and improve overall well-being.
• Rehabilitative and habilitative services and devices: Massage therapy can play a crucial role in rehabilitation and habilitation, aiding in the recovery from injuries, improving function, and enhancing overall mobility.
• Preventive and wellness services and chronic disease management: Massage therapy is often used as a preventive measure to maintain good health and manage chronic conditions such as muscle tension, pain, and circulation issues.
• Pediatric services, including oral and vision care: Massage therapy can be beneficial for children, especially those with special needs or developmental disabilities, as it can help improve circulation, flexibility, and overall well-being.

While massage therapy may fall under these categories, it is important to note that insurance coverage can vary depending on the state and the specific insurance plan. Some states may include massage therapy as a covered service, while others may exclude it. Additionally, insurance companies may have different definitions of massage therapy and specific criteria for coverage. Therefore, it is essential to verify coverage with the insurance provider and understand the limitations and requirements.

To increase the chances of insurance coverage for massage therapy, it is recommended to obtain a referral or prescription from a primary care physician. This is because massage therapists are typically not licensed to diagnose medical conditions, and a referral from a doctor can enhance the likelihood of reimbursement.

Frequently asked questions