Are Massage Therapy Services Covered by Medical Insurance, Medicare, or Medicaid?

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.

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.

Neal Lyons is a founding member and volunteer contributor at the MTSI Institute, an information based portal dedicated to guiding and assisting aspiring massage therapists establish a successful career in massage. Neal is a published author and has collaborated on several mobile applications that serve the massage profession. You can view his published work on Amazon, iTunes, Barnes & Noble, Sony and Kobo. You can connect with him on Facebook, Twitter and on Google+

Posted in Business - Other, Career Considerations
18 comments on “Are Massage Therapy Services Covered by Medical Insurance, Medicare, or Medicaid?
  1. Stefany Scales says:

    I’m doing a research paper on massage and the insurance industry and why they struggle to cover massage and I came across your article and I was wondering if you could help me out in citing portions of your article. Thank you

  2. JAYNER WILLIAMS says:

    PLEASE HELP ME WITH MY BODY PAIN!!!

  3. Leslie says:

    Interesting and helpfull information. Thanks for shearing

  4. Bee, LMT says:

    Hi, My name is Bee. I own my own massage therapy business. How do I make myself available and connect with providers to let them know I would like to be a part of their network to offer massage.

  5. Shae says:

    Hello Bee, I have my own massage therapy office and would like to begin to accept insurance but is confused as to what is the 1st, 2nd and 3rd step to allowing this dream to happen. I have a lot of clients that are unable to be seen due to the expense of the therapy, but is in dire need due to certain accidents/incidents. Any advice would be golden at this point. Thanks in advance!

    • Neal Lyons says:

      Shae – massage can qualify under insurance if you have chiropractic services attached to it – but in some states. many states are constantly changing their rules but generally you’d have to be associated with chiropractic services. have you been able to successfully accept insurance? if so, please share with us how you accomplished this?

      • Mary Rose says:

        I would also be very interested. I, too would like to bill insurance for my services without going through a Chiropractic office. 🙂

        • Neal Lyons says:

          not sure that is possible currently. are there any readers out there who can chime in and clarify/correct us? is there a way massage therapists can offer services and bill through health insurance?

        • Joel says:

          Depends on which state you’re in, Mary Rose. Massage therapists in Washington State have been able to bill medical insurance since around 1998. New York State also allows MTs to bill. Currently, I believe there are 23 states that allow it.

          • Neal Lyons says:

            TX also allows it but through a chiro affiliation. Joel – do you have any resources you can share on where folks can find more info on which states allow billing insurance companies for massage services as well as how does a massage establishment go about getting approved for this?

          • Joel says:

            The answer is rather like the box within a box within a box within a box. Let me explain…

            The first step is to determine whether your state legislature has deemed licensed massage therapists as Healthcare Professionals (HCPs). Under Section 2706 of the ACA, that seems to be a requirement. There should be something in the state’s laws that specifies this. They could be in the MT laws, insurance laws, or even in the healthcare laws.

            In at least one state, Maryland, you must have the higher tier MT license in order to bill, not the original basic license. Other states may have this requirement, too.

            After that, your next mission is to find out which insurance companies in your state actually cover massage therapy. And out of those, which ones cover massage therapy by an actual massage therapist without supervision of a physical therapist, chiropractor, or medical doctor.

            Your best bet is to get credentialed with each individual insurance company. It may be easier to go through CAQH instead of doing it the long way. This in itself may be a big challenge. Often, insurance companies only allow a certain number of professionals in each occupation and close the books once their quota is filled. You may have to wait months or years for a space to open, and they don’t notify you; you have to keep checking back with them.

            You may be able to bill out-of-network. It is likely they will pay you at a lower than in-network rate. That is, if they pay you at all.

            Finally, the reimbursement rates seem to keep falling over the years, even in Washington State, which is the first state to allow MTs to bill. It was their Insurance Commissioner who got their state’s laws changed to allow MTs to bill and for the carrier to pay. However, they’ve been in constant battle in the legislature about knocking MTs out of the system. I don’t know who the drivers are in either group. I’m in New Hampshire.

            Last thing — Julie Onofrio is in Washington State. She is a LMP there and also writes on many aspects of massage business, insurance billing, and website building. She wrote at least one book on insurance billing, which is only basic, admittedly. But it’s a start.

        • Joel says:

          In some states, chiropractors have had their ability to provide and bill health insurance for massage therapy taken away. That’s the case here in New Hampshire. Physical Therapists managed to make that happen a few years ago, not that PTs necessarily provide massage therapy. But they wanted to corner the market on the business and chiros were cutting into that.

          • Neal Lyons says:

            Joel – correct. we always wondered how chiros were able to get away with that, taking market share from non chiro associated massage therapists. do you know how they are able to do that in certain states?

  6. kathy friedlander jepsen says:

    i am a 53 yr old female. seek this avenue of alternative therapy. and have access to it. however what insurance is available that approves this? does anyone have any names advice. absolutely blind as to find or go about it. have been on medicare and have refused the usual vicodin.for pain thing. would love any help anyone has to give.

    • Neal Lyons says:

      Kathy – we recommend contacting local chiropractor offices and asking whether they offer medical massage services. this is the only way we are aware of insurance being able to cover massage therapy services.

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