Many clients ask if massage therapy is covered under their insurance. Depending on the state you live in and whether massage therapy is licensed in your state (it is in Illinois) and on what type of insurance coverage you have, the answer could be yes.
Massage is considered as Alternative and Complementary Medicine and is recognized by the Affordable Healthcare Act as a “non-essential” benefit, therefore insurance companies are not required to cover it. The AHA mandates that insurers cannot discriminate against any licensed healthcare professional such as chiropractors, acupuncturists and massage therapists, yet it does not mean required coverage. They can, however, limit coverage to services that are deemed medically necessary or the number of visits you can receive. They may also require documentation or a prescription from the physician.
So how does one go about inquiring if their health insurance carrier covers massage? Here are a few questions to ask about coverage:
1. Am I covered for massage therapy?
2. Should I acquire a prescription or referral from my primary physician or chiropractor?
3. Is there a limit on number of visits?
4. What will my out-of-pocket cost be?
Massage therapists typically are not able to become providers for insurance companies or be “in-network” because the training and licensing requirements vary so much from state to state, therefore, they are not able to classify the massage as a legitimate service. Not only that, the discount that insurance companies ask of providers would be too great for a small practice to bear. Offering packages, wellness plans, rewards points, etc. are ways to make massage affordable and add value to clients who need more regular massage therapy.
Recently, Dr. Mark Severance, D.C. and our staff attended an insurance reimbursement seminar for chiropractic and massage therapy. There are only a couple of codes that apply to massage. The codes are broken up into units of time – generally in 15-minute increments. Most, if not all, insurance carriers will not cover a full one-hour massage. The usual limitation is for a maximum of 2 units per day or 30 minutes for up to 6-8 visits and cannot be for the same area as what the chiropractor is treating on the same day. That is to avoid over-billing of services and to not allow for over-treating a patient. Medical supervision is required to render massage therapy services, so most massage centers or spas would not qualify as a viable service for reimbursement. Since we do have a chiropractor on staff, we are qualified to render massage for reimbursement by your carrier.
Carriers also require a diagnostic code and may require documentation of health goals, treatment plan and progress of the condition. Make sure the establishment you visit for services knows how to properly document and fill out the appropriate forms. Some carriers will cover Manual Lymphatic Drainage for edema and post-surgery healing (for example), injury rehabilitation, especially related to a personal injury or worker’s comp case or therapy in conjunction with a chiropractor.
To facilitate reimbursement for our clients/patients, we will fill out the appropriate forms once payment is received at the time of service. We can supply notes and documentation whenever the carrier requires them. If more than one area needs to be treated and more time allotted for over 30 minutes, that is usually considered an out-of-pocket expense.
Our hope is that with all of the research studies that continually support the benefits of regular massage therapy, chiropractic and acupuncture that one day these services will be considered primary care services and that insurance carriers will soon come to realize that it is the more cost-effective solution to pain and stress management. Studies have already shown that by incorporating these services into healthcare, it can be the answer to the opiate abuse problem we now face in our society.
Whether massage is covered or not, one thing is evident…the benefits of receiving regular massage therapy far outweigh any “pains” of out-of-pocket expense you would incur and that the cost of prevention is not something you can measure in the present. Feeling good and investing in your health is priceless.
Sandy Saldano, Lic. Massage Therapist
Owner of Therapeutic Kneads, Ltd.
847-266- 0131