For many people suffering from ongoing pain, massage therapy is an important component of their treatment plan.
It’s become especially important to recognize massage as a pain-relief method as the country faces an epidemic of opioid abuse. Doctors and patients are turning to alternative methods, which include non-opioid medications and therapeutic massage.
But when it comes to massage, how can you be sure that your health insurance provider will cover it?
There’s no guarantee that every insurance provider will cover massage therapy, but these tips can help:
1. Call to verify your insurance coverage for massage therapy
There are some important questions to ask your insurance company. Contact a representative through the customer service number (usually on the back of your insurance card).
Example questions:
- I’ve received a prescription for medical (or therapeutic) massage written by my medical doctor. How do I know if it’s a covered service in my plan?
- Does my prescription for massage need to have a particular diagnosis (such as “back pain”) or diagnosis code number (such as “M54.6”)?
- What else needs to be included in my prescription, and what kind of doctor needs to prescribe this for me?
- Will my plan cover my diagnosis of “back pain”? (This applies if you already have a diagnosis from your doctor.)
- Do I have any limitations on the number of visits or length of time for each visit? (If your insurance representative says each visit is limited to a certain number of “billing units,” ask how long each unit lasts.)
- Where can I schedule a massage that is in-network with my plan? Is the licensed massage therapist in-network with my plan only at that location or facility?
2. Get a prescription by clearly communicating to your doctor that you’d like massage therapy
Say you’re having muscle pain and, based on your lifestyle, pain history and research, you think massage therapy is a reasonable option. Describe all of this clearly to your doctor.
For example: “I have low back pain, and it may be because I’m sleeping a certain way, but I’m not sure. I’d like to try massage therapy based on what I’ve read about its benefits for acute pain, and I’d like a licensed massage therapist to help me figure out why it’s happening and correct it. If it doesn’t improve, then I’d like to talk about pain medication options. Would you recommend this for me?”
Depending on your situation, your doctor likely will be open to prescribing massage. Licensed therapeutic massage is safe and non-addictive, and medical research consistently supports its effectiveness as a pain-management treatment.
3. Ask your doctor to prescribe massage for the most general diagnosis possible
A prescription of massage therapy for “muscle pain” allows a licensed therapist to adjust treatment to your problem more easily and quickly.
For example, you may have pain in your left ankle, but it later turns out that your ankle pain resulted from lower back pain you’ve been compensating for over time.
Because massage therapists can’t write prescriptions or diagnose patients, they must do exactly what the prescription asks. If your prescription specifically asks for massage in the area of your left ankle, a massage therapist won’t be able to begin treating your lower back unless you obtain an updated prescription from your doctor.
4. If possible, get a prescription that doesn’t specify the frequency and number of massages
A prescription that says exactly how many massages are needed or how many you should receive each week doesn’t always lead to the best treatment plan.
When licensed massage therapists meet with patients, their goal isn’t just to offer therapy, but also to identify how the person came to have this pain. They’ll evaluate habits, such as crossing the legs a certain way, that could be adjusted to prevent pain.
There may also be a cause that a patient won’t want to change – maybe their cycling posture contributes to back pain, but they love cycling and don’t want to stop. At that point, massage therapy becomes regular maintenance for the patient. In these scenarios, the problem is difficult to fix in a limited number of appointments.
Getting in for an appointment at the times dictated in a prescription also can become difficult between therapist and patient schedules, or if there is a gender preference in therapist that needs to be accommodated.
Massage therapy may be the key to reducing pain for you, whether you’re suffering from muscle aches, arthritis, headaches or even fibromyalgia. Licensed massage therapists can contribute to your physician-managed treatment plan and help you learn better self-care strategies.
Caitlin Merriman, a licensed massage therapist, is the program manager for Massage Therapy at Ohio State Integrative Medicine.
Massage therapy can have many medical benefits. It can relieve muscle tension, improve circulation, and help with pain relief, stress, and anxiety.
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.
Learn about massage therapy insurance coverage and how to find out whether your provider covers it.
Are Massages Covered by Insurance?
With many people turning to massage therapy as a medical treatment, it seems that health insurance should cover massages. However, not all policies do.
For example, Medicare does not cover massage therapy, so you will likely be responsible for 100% of the costs if you seek this treatment. Even if your health insurance provides coverage, there may still be limitations.
The definition of massage therapy may vary, depending on the insurer. That definition of massage, and the reason you’re getting one, will likely determine whether insurance will cover it.
If massage treatment isn’t covered in your policy, be sure to ask about alternative options. It’s also a good idea to discuss them with your doctor.
Note
If you are eligible for services from osteopaths, chiropractors, occupational therapists, and physical therapists who also use massage techniques, these visits may be covered by your insurance.
There is no standard requirement for insurance companies to reimburse expenses for massage. Massage therapy may be covered:
- When the massage is considered medically necessary and/or fits the definition and criteria of coverage given by the insurer.
- If the massage fits into the criteria of a “habilitative or habilitation” treatment, it may be covered by health insurance as an essential health benefit. Talk with your doctor and your insurance company to be sure.
The best way to find out whether massage therapy is covered is by asking your insurance company directly.
How to Get Your Massage Therapy Covered
If you want your insurer to cover massage therapy, you may have to have your massage therapy prescribed or recommended by a doctor.
In a survey by the American Massage Therapy Association (AMTA), many patients reported that their doctors are looking to massage therapy as a complementary option for addressing their health concerns.
Of the patients who talked about massage therapy with their doctors:
- 25% were referred to a massage therapist.
- 24% said they were strongly recommended by their doctor to receive a massage.
- 23% said their doctor encouraged them to get a massage.
- 19% were told that a massage might benefit them.
Before booking a massage, make sure the massage provider is accepted by your insurer. Find out whether the massage must be deemed medically necessary in order to be covered. If so, ask how to meet the criteria.
Questions to Ask About Massage Therapy Coverage
If you learn that your insurer covers massage therapy, ask these questions so you will understand how your policy will cover it:
- What are the conditions to qualify for reimbursement?
- Is there is a deductible or any out-of-pocket cost to you?
- Is there is a maximum amount payable per policy term/year?
- Is there a maximum reimbursement per visit? For example, if the maximum per visit is $90, and you use a massage therapist who will charge $150, you will not be able to claim the full amount.
- Is there a time limit per body region?
- Are there specific massage therapists you must go to?
- Do all types of massage qualify for coverage?
Tip
If you and your spouse each have health insurance through an employer, you may be able to claim under both of your insurance plans using coordination of benefits. If massage therapy would be covered, you could get the maximum from both plans, thus doubling your coverage.
How Much Does Massage Therapy Coverage Cost?
Like all benefits, the more coverage a policy offers, the more it’s likely to cost. The cost will vary by insurer.
Signing up for health insurance through an employer can save you money. That’s because the employer will often pay part of the cost of the premium for you. It may also offer health insurance plans with more benefits, like massage therapy.
If the massage is considered rehabilitative or is medically necessary, then insurance will not cost you more. It may fall under the coverage of the Affordable Care Act’s (ACA) 10 essential health benefits.
What If Your Massage Isn’t Covered?
If your massage therapy isn’t covered by your insurance, consider these options to help you find and receive affordable services:
- If you have a health savings account (HSA), you may be able to use it to cover massage costs if it qualifies as medically necessary. Learn more about HSAs and flexible spending accounts (FSAs).
- Contact local massage schools to see whether they offer massages at a discount.
- Ask for discounts where you get your massage services.
The Bottom Line
Health insurance may provide coverage for massages that are medically necessary or prescribed by your health provider. But even when health insurance covers massage, there may be a limit or maximum amount payable during a policy term.
Before getting a massage, check with your insurer to determine whether it is covered. If it’s not covered as a massage, find out whether there is coverage for physiotherapy from chiropractors or other related specialists.
Be sure to discuss these options with your doctor. If your doctor prescribes massage therapy as part of a treatment plan, that may allow you to claim it on your insurance.
Frequently Asked Questions (FAQs)
How do you find a massage therapist who accepts your insurance?
The easiest way to find healthcare that your insurance covers is to check your insurance network and see which massage therapists are available near you. You can also call individual providers to ask whether they accept your coverage and whether a doctor’s referral is required. Be sure you confirm that they accept your coverage before you receive services.
Why doesn’t insurance always cover massage therapy?
Massage therapy is considered an alternative treatment, and insurers often won’t cover these types of treatment outright. In many cases, a referral from a licensed medical provider will overcome this barrier.
