Massage therapy is used for a variety of reasons. One example is post-accident injury. After an accident, such as that from a car crash, persons involved in the accident may require or otherwise benefit from massage therapy to make a full and lasting recovery.
Other medical conditions or consequences of injury may also require massage therapy for a full and fast rehabilitation. Massage therapy can also be recommended or prescribed by a doctor, such as a chiropractor.
So does Medicaid cover physical therapy? Or more importantly – what does Medicaid not cover?
One question that many potential clients of massage therapy ask is if massages are covered by their medical insurance provider, Medicare, or Medicaid. The following information will help answer this question and other related issues you may run into when dealing with massage as a medical treatment or alternative.
Who Likely Provides Reimbursable Coverage and Who Does Not
Unfortunately for Medicare and Medicaid recipients, massage therapy is generally not covered or reimbursed. The same is often true for persons covered under a Health Management Organization (HMO).
It is possible for massage therapy to be covered by these as well as major insurance companies, but it depends on the policy held by the patient or client as well as the state where they live and receive massage treatment. For example, does Medicaid cover physical therapy in a nursing home? The answer may very well be yes given the patient’s circumstances.
Different states have different laws and requirements in order for massage therapy to be covered or reimbursed after the recipient pays for the massage out of their own pocket.
Insurance types that are likely to pay in whole or in part for massage therapy services, either directly or through reimbursement are: major medical providers such as Humana, Blue Cross, Aetna, etc. Worker’s Compensation, and the Personal Injury Protection (PIP) provided by auto insurance companies in the event of an injury sustained from an auto accident.
Again, this depends on the coverage under the client or patient’s health insurance plan, although some states mandate that they cover massage therapy services should all of the requirements are met.
What This Means for the Client
Clients or patients who may benefit from massage therapy for medical reasons will have to do some personal research. This means contacting the insurance company to see if massage therapy is covered or not under their medical insurance plan.
In certain cases, such as Worker’s Compensation or PIP, services may or may not be covered based on the conclusions of the claims adjustor who investigates the claim. For the client, proper filling of claim forms or other required documents is a must in order to be covered for massage therapy sessions.
Also, the patient may be required (in most cases it will be) to have a referral from a doctor, chiropractor, or other recognized medical professional. A prescription is also likely required, so the patient should be prepared for long phone calls and reading sessions through their provider’s literature to find out if massage therapy is covered.
Also, the client or patient will have to find a licensed massage therapist (LMT) that accepts insurance. Not all massage providers accept (or can accept) insurance. There are several reasons for this, which are covered in the next section.
Accepting Insurance Plans and Coverage as a Massage Therapist
Not all massage therapists accept insurance. Some of this is by personal decision and others may not be allowed to do so. The biggest reason a therapist may not choose to accept insurance is the headaches that come with the process. Accepting insurance requires a substantial amount of paperwork.
Claim forms differ depending on the type of coverage that is paying or reimbursing for the therapy. If the claims are not filled out properly, the medical billing codes aren’t entered correctly, and other proper documentation is done incompletely or incorrectly, the therapist will not get paid for their services, which then results in business losses. This is especially hurtful to the individual therapist with a private practice. For this reason, many massage therapists will not accept insurance.
Another reason LMT’s may not accept insurance is because they are not allowed to do so. Most states require massage therapists to be licensed, but sometimes that is not enough. States may differ on what requirements a massage therapist must meet in order to accept insurance. Virtually all states require a therapist to be licensed in order to legally offer massage therapy services.
Massage licensing requirements differ from state to state as well. In most cases, once a therapist is properly licensed and certified according to their state’s guidelines, they can bill insurance companies. Therapists should research their state’s laws in order to discover if any additional requirements must be met in order to be allowed to bill insurance companies to receive reimbursement for services provided. A prime example of this is CPR training, which while required by some states is not required by all.
In work-related injury or auto injury cases (Worker’s Compensation and PIP), all states allow LMT’s to bill for services provided. In order for this to be done properly, the client must have a referral from their physician.
Advice for Massage Therapists
For any LMT that wants to accept insurance, they will need to check with their state’s governing board to see what requirements must be met in order to bill insurance companies other than Worker’s Compensation and auto insurance PIP.
Also, it would be a good idea to check with insurance providers in case the client hasn’t done the proper checking to see if massage therapy services are covered. LMT’s who wish to accept insurance may also want to hire a medical billing and coding professional to ensure that the proper codes are entered in the proper places and claim forms are filled out correctly. Making sure detailed recordkeeping is performed will ensure that the LMT will get reimbursed for their services.
The Reason Why There is So Much Ambiguity Accepting Insurance for Massage
There is one main reason that clients and therapists alike experience such headaches when dealing with insurance, being covered, ability to accept insurance, being reimbursed, etc. This reason is the current classification of massage therapy in the broader set of medical services.
Massage therapy falls under a treatment category known as Alternative or Complementary Medicine. It is not defined under the Affordable Healthcare Act as essential benefits, thus insurance companies are not required to cover it.
Also, insurance companies tend to not cover massage therapy as it is not under strict regulation and can’t be completely verified as legitimate. There is hope that this will change so clients who need massage therapy coverage and LMT’s who wish to accept insurance won’t have to go through a nightmare of paperwork and bureaucracy to receive or provide treatment.
Many practitioners and business owners are definitely on a quest to get Medicare to pay for massage therapy. Time will tell whether patients can get massage therapy as part of their government insurance plans.