Wednesday, April 17, 2024

Massage Therapy Covered By Medicare

Is Lymphedema Massage Covered By Medicare

Is restorative/recovery massage a covered service billable to Medicare?

Medicare coverage for lymphedema therapy is limited. Benefits do include manual lymphatic drainage, which is also known as lymphedema massage. To be covered, it must be performed by a qualified Medicare provider, such as a physical or an occupational therapist. Medicare doesnt cover compression garments but, in some cases, will cover a lymphedema pump if compression therapy doesnt work.

Massage Therapy And Healthcare Policy

CMS encourages Medicare Advantage plan providers to include massage therapy coverage for pain management. Some alternative therapies are considered a safer substitute for opioids and other addictive substances prescribed to patients suffering from chronic conditions or injuries.

According to CMS, 270 plans are now offering therapeutic massage therapy, along with other supplemental benefits like adult day care, caregiver support, and home-based palliative care. In 2019, 1.5 million Medicare beneficiaries were able to take advantage of these new benefits.

CMS has stated that it plans to expand coverage into new types of benefits in 2020 and beyond, which is good news if youre interested in massage therapy options under Original Medicare.

Is Massage Therapy Covered By Insurance

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 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 , 23.5% of American adults spend money on complementary health measures at least once during the year.

Learn about massage therapy insurance coverage and how to find out whether your provider covers it.

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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?

Do You Have Coverage For Massage

Does Medicare cover massage therapy? Information and costs

Massage therapy may be defined in several different ways by an insurance company. How it is defined and the reason for getting the massage will determine whether you will be covered by your insurance.3 If a massage therapist treatment isnt covered in your policy, be sure and ask about these alternative options and discuss them with your doctor.

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 health insurance company.
  • 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. You would have to speak with your doctor and your insurance company to be sure.

More health insurance companies are starting to cover massage therapy, so the first thing you need to do to find out if its covered in your situation is to ask your insurance company directly.

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Therapy Not Covered By Insurance

If your health insurance does not cover massages, but you have a health savings account , you may be able to use it to cover massage costs, if your massage qualifies as medically necessary. Learn more about HSAs and flexible spending accounts here. Contact local massage schools to see whether they offer massages at a discount. Ask for discounts or membership options where you get your massage services.

Does Medicaid Cover Lymphedema Therapy

  • Does Medicaid cover lymphedema therapy? Discover which lymphedema therapies are covered by Medicaid and Medicare and what to expect at a lymphedema clinic.

Lymphedema is a condition where lymphatic fluids dont drain properly. It causes tissue swelling, often in the arms and legs, and can impact a persons ability to move, cause skin changes and increase the risk of infection. Its estimated that as many as 5 million Americans are impacted by the condition, which can be caused by certain congenital diseases or as a result of cancer or damage to the lymphatic system. There are a variety of techniques that can help reduce swelling, so its important to know whether Medicaid covers lymphedema therapy.

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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 allow doing 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 not filled out properly.

The medical billing codes arent entered correctly.

And other proper documentation did incompletely or incorrectly.

The therapist will not pay 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 LMTs may not accept insurance is because they not allowed to do so.

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For any LMT that wants to accept insurance.

They will need to check with their states governing board to see what requirements must meet in order to bill insurance companies other than Workers Compensation and auto insurance PIP.

Also, it would be a good idea to check with insurance providers in case the client hasnt done the proper checking to see if massage therapy services covered.

LMTs who wish to accept insurance may also want to hire a medical billing.

And coding professional to ensure that the proper codes entered in the proper places and claim forms filled out correctly.

Making sure detailed recordkeeping performed will ensure that the LMT will reimburse for their services.

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Risks Of Massage Therapy

Risks of massage are rare, but can include:

  • Nerve injury
  • Blood clot
  • Bone fracture

You may need to avoid getting a massage if you have a bleeding disorder, burn, open wound, deep vein thrombosis, fracture, severe osteoporosis, or severe thrombocytopenia. Also talk to your doctor about whether you should get a massage if you are pregnant, have cancer, or have unexplained pain.

When getting a massage, be sure to speak up and let your therapist know if anything is hurting or uncomfortable. Most therapists will ask you whether the amount of pressure is okay.

Dont use massage therapy as a substitute for medical care. Be sure to see a doctor if you have persistent health problems.

Changes In Reimbursement For Massage Therapy Services

To: Licensed Massage Therapists

Contracts Affected: Members with a benefit rider that includes coverage for massage therapy

Effective December 1, 2019, BlueCross BlueShield of Western New York is changing the process for how massage therapy services should be submitted for processing. For dates of service December 1, 2019 and forward, massage therapy services, CPT code 97124, will be reimbursed based on a per unit basis.

We want to help you understand our payment for the Massage Therapy procedure, as well as any modalities. Please consider the following:

  • We reimburse per unit for the therapy service according to our fee schedule. This includes the application of a modality.
  • The appropriate Current Procedure Terminology codes for Massage Therapy services are:
Description CPT Code
Therapeutic procedure, one or more areas, each 15 minutes massage, including effleurage, petrissage and/or tapotement 97124
Treatment and Therapy Modalities 97010-97140

To verify that your patient has this benefit, please log into HEALTHeNET.

Fee schedules can be viewed by logging into our secure provider portal on our website. For more information, please contact Network Management at .

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Other Types Of Therapy Covered By Medicare

If you were interested in massage therapy as a form of pain management, there are other types of treatments offered by Medicare under some circumstances. This includes medication management, occupational and group therapy.

Medicare Part D, an optional benefit that covers prescription drugs, could also help with pain management by providing more access to medications.

Medicare will also cover physical therapy if it is medically necessary and used to treat an injury or illness, like recovery from an accident or medical emergency.

Part A will cover inpatient physical therapy at a rehabilitation facility, while Part B will cover at-home or outpatient physical therapy. Massage could be part of physical therapy treatment.

Chiropractic care is covered by Medicare if there is a bone in your spine that is out of position. Acupuncture treatments for chronic lower back pain are covered, yet cap at 12 appointments in a 90-day span. You will typically pay 20 percent of the cost for most of these services.

The Reason Why There Is So Much Ambiguity Accepting Insurance For Massage

Massage Therapy: Does Medicare Cover It?

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 not required to cover it.

Also, insurance companies tend to not cover massage therapy as it is not under strict regulation and cant be completely verified as legitimate.

There is hope that this will change so clients who need massage therapy coverage.

And LMTs who wish to accept insurance wont 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.

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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 , 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.

Massage Therapy Vs Physical Therapy

Although there is some overlap between massage therapy and physical therapy, the two have different treatment methods and objectives.

Physical therapy focuses on rehabilitating body parts to return them to full function. Physical therapists help improve mobility and restore range of motion to limbs and joints. A physical therapist may use therapeutic massage techniques to treat a sports injury, among other treatment methods.

Occupational therapy is very similar to physical therapy. However, the occupational therapists job is to help people manage activities of daily living, such as eating and dressing themselves.

While physical therapy aims to restore movement throughout the entire body, massage therapists, on the other hand, focus on relieving muscle tension, pain, and stress.

These experts use different massage techniques to manipulate muscles, tendons, and soft tissues, but their scope of practice is limited to soft tissue massage.


If your Medicare Advantage plan covers massage therapy, its important to find out how the benefit is handled.

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What Therapy Services Are Covered By Original Medicare

Original Medicare only pays for therapy services that are considered medically necessary.

If a therapy service is considered medically necessary, Medicare Part B typically pays 80 percent of the cost for the service and you pay 20 percent . In 2022, the Part B deductible is $233 per year.

If your therapy service is not medically necessary, your therapy provider must give you a written notice called an Advance Beneficiary Notice of Noncoverage before providing the service.

The ABN enables you to choose whether you want the therapy service. If you choose to get a service that is not medically necessary, you are responsible for 100 percent of the costs.

Understanding Massage Therapy Benefits

Medicare Guidelines for Massage Therapy as A Covered Service 97124 #MCRHybrid

One of the problems with insurance coverage for massage therapy is that state licensing laws determine whether therapists can bill insurance companies for their services. Each state has different requirements, with some not allowing insurance billing at all.

Another problem is that many massage therapy services arent standardized for insurance billing. This makes it difficult for an insurance company to standardize its benefits.

Insurance companies generally handle massage therapy benefits in one of two ways. They either pay a flat amount for a massage therapy session, or they offer an annual massage therapy allowance.

If your Medicare Advantage plan covers massage therapy, its important to find out how the benefit is handled. You should also ask about any coverage restrictions that may apply. Some plans require a doctors order and proof of medical necessity. Others may only pay for services with certain massage therapy providers.

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With Massage Therapy Coverage Cost

Like all benefits, the more coverage a policy offers, the more it usually costs. The cost will vary by insurer. Taking health insurance through an employer can save you money because the employer will often pay part of the cost of the premium for you, and 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, as this may fall under the coverage of the Affordable Care Acts 10 essential health benefits.

Massage Therapy And Hsas

If you have a health savings account , you may be able to use those funds to pay for massage therapy. To count as a qualified expense, the massage therapy must be deemed as medically necessary. Generally, a letter from your doctor will suffice to prove such services as a medical necessity.

Although Medicare currently doesnt cover most massage therapy services, that could change as its role evolves as an accepted medical treatment.

The good news is that even if your Medicare Advantage plan doesnt offer massage therapy benefits, you may still be able to get affordable treatment. If you have a local massage school nearby, you may get massage therapy at a steep discount. Many massage therapy practices also offer membership options that lower the cost of individual sessions.

If you do have massage therapy benefits with your Medicare coverage, be sure that you fully understand the specific benefits available to you before you book a massage. That way, youll avoid any unpleasant surprises at billing time.

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Amta Working On Getting Massage Covered By Medicare

AMTA is working on getting massage covered by Medicare with the Alliance to Advance Comprehensive Integrative Pain Management and it looks like CMS is actually paying attention.

AACIPM says: However, the efforts of AACIPMs many stakeholders were not for naught, as recommendations #2 and #4 from our letter were directly quoted by CMS in their summary of public comments, as they wrote: One commenter recommended that CMS establish a multi-stakeholder working group to determine operational details and resource allocation and requested that CMS establish a pilot program using innovative payment methodologies.

I see a plan starting something like this:

  • Contact legislators about a bill.
  • Write letters to legislators.
  • Do we need a lobbyist to help right it? That costs probably $10k a month or so .
  • Create a document with info that shows how massage can help with top medical conditions to give to legislators.
  • Figure out how much this would cost and start a fundraiser.
  • Contact AMTA and ABMP to see what they are doing.
  • Start applying to be a Medicare/Medicaid Provider even though they are not accepting Massage therapists as providers.
  • Start sending them bills even though they do not pay so they can be denied just to get into the system.

Verifying Insurance Coverage & Reimbursement For Massage Therapy

Chris Clark, Author at Medicare Plan Tips

At the current time, there is no standard coverage for massage therapy services within large insurance providers. This means getting coverage comes down to the reason for care and how that care is defined to the insurance company. Usually, if the treatment is medically necessary, or it fits the criteria of coverage provided by the insurance company, your client will be covered and you will be reimbursed. Additionally, if the services fit into the category of âhabilitative or habilitation treatment,â it may be considered an essential health benefit and your client will receive coverage. Many insurance companies deem massage therapy necessary in the acute phase of treatment, rather than as a long term care procedure.

An easy way to increase your chances of massage therapy being covered by insurance is to ask your clients to obtain a referral from their primary care physician. In a recent survey conducted by the American Massage Therapy Association, 67% of respondents indicated that their primary physician recommended they receive massage therapy. A prescription or referral from a physician is important for reimbursement because massage therapists are not licensed to diagnose medical conditions. With a referral from a doctor, the massage therapist can include the ICD-10 diagnostic code and referring provider on their CMS-1500 form, and increase their chances of reimbursement.

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