Orlando Harmon
Massage therapy can be an expensive treatment option, but some insurance companies may help cover the costs. Massage therapy is now recognised as a legitimate healthcare service, and in some cases, a legitimate alternative to opioid-based pain relief. However, it is not always straightforward to get reimbursed by insurance companies for this treatment. It is important to check with your insurance company whether they will cover the costs of massage therapy, as it depends on how the treatment is classified by the company and whether it is deemed medically necessary. Some insurance companies that cover medically prescribed massage include BlueCross/Blue Shield, United Health Care, Cigna, and Aetna.
| Characteristics | Values |
|---|---|
| Insurance coverage for massage therapy | There's no guarantee that every insurance provider will cover massage therapy. |
| How to secure coverage | Obtain a physician referral or prescription with an ICD-10 diagnostic code. |
| Insurance reimbursement | Submit a Superbill (detailed receipt) to your insurance company for potential reimbursement. |
| Insurance coverage by state | Coverage varies by state. All 50 states reimburse for massage therapy related to workplace injuries or motor vehicle accidents. |
| Insurance coverage by company | Private insurance may have upgraded plans that include massage. Some companies that cover medically prescribed massage include BlueCross/Blue Shield, United Health Care, Cigna, and Aetna. |
| Alternative payment options | Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) allow clients to use pre-tax dollars for qualified medical expenses, including medical massage therapy. |
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What You'll Learn
Physician referrals and prescriptions
While it is rare for regular health insurance companies to pay for massages, there are some ways to get a physician referral or prescription for massage therapy that can be covered by insurance. Firstly, it is important to note that not all insurance providers will cover massage therapy, and some may not cover it even when prescribed by a physician. Therefore, it is advisable to first contact your insurance company to verify coverage for massage therapy and understand their specific requirements.
If your insurance plan covers massage therapy, the next step is to schedule an appointment with your physician to discuss your needs. Clearly communicate your symptoms, such as muscle or back pain, and explain why you believe massage therapy would be beneficial based on your research and pain history. If your physician agrees, they can provide a referral or prescription for massage therapy. This referral or prescription is crucial, as many insurance companies will not cover massage therapy without it.
The referral should include specific information such as the start date, the number of visits prescribed, the frequency of sessions, and diagnosis codes referencing your injury or condition. Diagnosis codes are particularly important, as they are required to claim massage therapy sessions with your insurance company. Once you have the referral, you can locate a reputable massage therapist who is licensed in your state or area and confirm that your insurance will cover their services.
It is important to note that some massage therapists may not be able to directly bill your insurance company, so you may need to claim the therapy yourself by submitting reimbursement requests along with your receipts and the referral or prescription. Remember to submit these documents as soon as possible after your massage therapy session to ensure timely reimbursement.
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Insurance reimbursement
Massage therapy has gained recognition as a legitimate healthcare service in recent years, especially as a non-opioid pain-relief method. However, there is no guarantee that insurance providers will cover it, and reimbursement isn't always straightforward.
Firstly, it is important to understand the difference between general and medical massage therapy. Medical massage therapy is tailored for specific medical conditions, aiming to treat injuries, improve function, and enhance circulation as part of a structured treatment plan.
If you are seeking insurance reimbursement for medical massage therapy, it is crucial to carefully navigate the payer requirements. Here are some key steps to follow:
- Verify your insurance coverage: Contact your insurance company to confirm if massage therapy is covered under your plan. Ask specific questions about your coverage, including any limitations on the number of visits or the length of each visit. Inquire about in-network providers and whether coverage is restricted to certain locations or facilities.
- Obtain a physician referral or prescription: Since massage therapists cannot diagnose medical conditions or write prescriptions, a physician referral or prescription is often required for insurance reimbursement. Communicate your symptoms and pain clearly to your doctor and express your interest in trying massage therapy as a reasonable option. Ask for a prescription with the most general diagnosis possible, such as "muscle pain," to allow for flexibility in treatment.
- Understand diagnosis codes and billing units: When receiving a prescription for massage therapy, inquire about diagnosis codes and billing units. Some insurance plans may require a specific diagnosis or diagnosis code, such as "back pain" or a specific code like "M54.6." Understanding billing units is also important, as each visit may be limited to a certain number of units, impacting the length of each session.
- Check state-specific regulations: Coverage for massage therapy can vary by state. While all 50 states reimburse for massage therapy related to workplace injuries or motor vehicle accidents, some states have different regulations. Familiarize yourself with your state's policies to maximize your chances of reimbursement.
- Ensure proper coding for billing: If insurance coverage is available, use the correct CPT (Current Procedural Terminology) codes for billing. The primary code for medical massage therapy is CPT code 97124, which pertains to therapeutic massage for treating musculoskeletal pain or injury.
- Explore alternative payment options: If insurance reimbursement is not available, consider alternative payment models such as Health Savings Accounts (HSA) or Flexible Spending Accounts (FSA). These accounts allow clients to use pre-tax dollars for qualified medical expenses, including medical massage therapy, providing a way to avoid out-of-pocket expenses.
Remember, each insurance plan is unique, and it is always best to contact your insurance provider directly to understand your specific coverage and requirements for reimbursement.
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Private insurance
Massage therapy can be costly, and while it is rare for regular health insurance companies to pay for massages, some private insurance companies may cover medically prescribed massages. These include BlueCross/Blue Shield, United Health Care, Cigna, and Aetna. However, it is important to check with your specific policy to ensure that massage therapy is included.
To increase the likelihood of insurance reimbursement, it is recommended to obtain a physician referral or prescription with an ICD-10 diagnostic code. Some insurance companies also require pre-authorization for services. Additionally, coverage may vary by state, and while all 50 states reimburse for massage therapy related to workplace injuries or motor vehicle accidents, some states extend coverage to physician-prescribed services.
If your private insurance does not cover massage therapy, there are alternative payment options available. These include Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA), which allow clients to use pre-tax dollars for qualified medical expenses, including medical massage therapy. Payment plans and third-party financing options, such as CareCredit or ClearGage, can also help make treatments more affordable by allowing clients to spread out payments over time.
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Medicare and Medicaid
Medicaid is a joint federal and state program that helps people on low incomes gain access to medical and mental health care. It covers therapy types like psychotherapy, CBT, marriage and family therapy. However, it does not cover massage therapy as it is considered a luxury item and not a healthcare necessity. The closest Medicaid options for similar treatments are chiropractic care or Osteopathic Manipulative Treatment given by a D.O.
Medicare, on the other hand, is another program that provides health insurance coverage for individuals. Original Medicare (Parts A and B) does not cover massage therapy by a licensed massage therapist as it is considered an alternative treatment and not deemed medically necessary. However, Medicare Advantage (Part C) plans offered through private insurance companies may provide coverage for massage therapy depending on an individual's health. These plans cover everything that Original Medicare does and often extend coverage to other areas, including vision, hearing, dental, and therapeutic massage.
To have Medicare Advantage cover massage therapy, you must meet certain conditions. Firstly, you need to seek treatment for a condition related to an injury or illness, such as chronic pain or limited mobility. Secondly, you must obtain a prescription or order from an in-network doctor for massage therapy to treat a covered medical condition. Lastly, you need to find a state-licensed massage therapist registered with your plan's network and has a National Provider Identifier.
It is important to note that even with Medicare Advantage, massage therapy may not be fully covered, and you may still owe a copayment or deductible. The cost of massage therapy can vary depending on factors such as region, massage type, and gratuity, typically ranging around $60 per hour.
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Alternative payment models
Massage therapy is often classified as an alternative treatment, making it ineligible for coverage under many insurance plans. However, there are some alternative payment models that can make massage therapy more accessible and affordable. Here are some options to consider:
Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA)
HSAs and FSAs allow clients to use pre-tax dollars for qualified medical expenses, including medical massage therapy. This method helps clients avoid out-of-pocket expenses while ensuring that providers receive full payment. To ensure eligibility for using HSA/FSA funds for massage therapy, proper documentation, such as a Letter of Medical Necessity, may be required.
Payment Plans and Third-Party Financing
Payment plans allow clients to spread payments over time, increasing affordability. If managing payment plans directly is not feasible, massage therapists can consider accepting third-party financing options such as CareCredit or ClearGage. These options allow clients to pay for services over time while ensuring providers receive full payment upfront.
Bundling Sessions into Packages
Instead of charging a high price per session, massage therapists can offer discounted rates for packages. For example, offering a five-session package at a lower rate than individual sessions can incentivize clients to commit to ongoing care while ensuring consistent business.
Insurance Affiliation
Some insurers allow massage therapists to affiliate with them. While this does not provide direct coverage for clients, it can give them access to discounted services at affiliated providers.
Physician Referral or Prescription
Since massage therapists cannot diagnose medical conditions, obtaining a physician referral or prescription with an ICD-10 diagnostic code increases the likelihood of insurance reimbursement. It is important to note that a prescription for massage therapy should ideally be for a general diagnosis, such as "muscle pain," to allow flexibility in treatment.
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Frequently asked questions
One of the most effective ways to secure insurance coverage for massage therapy is to obtain a physician referral or a prescription from your primary care doctor. Since massage therapists are not licensed to diagnose medical conditions, a physician referral with an ICD-10 diagnostic code increases the likelihood of insurance reimbursement. You can also submit a Superbill, which is a detailed receipt that clients can submit for potential reimbursement.
Some insurance companies that cover medically prescribed massage include BlueCross/Blue Shield, United Health Care, Cigna, and Aetna. Private insurance may also have upgraded plans that include massage.
If your insurance does not cover massage therapy, you can ask your insurance provider about alternative options they cover to help with your condition. You can also consider alternative payment options like Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) that allow clients to use pre-tax dollars for qualified medical expenses, including medical massage therapy.
