The answer depends on several variables—your Medicare plan, your medical condition, and even your chosen massage therapist. To avoid any unnecessary billing surprises, here’s what you need to know about Medicare and massage therapy.
What is Massage Therapy?
The Mayo Clinic defines massage therapy as “a complementary treatment that involves manipulating the body’s soft tissues.” Massage therapy, in order to be classified as a medical treatment, must provided by licensed and certified massage professionals.
Clinical studies show that massage therapy can help treat pain, reduce stress, and relieve muscle tension. In 2018, the Centers for Medicare and Medicaid Services (CMS) issued guidelines that must be met for the use of massage therapy to be deemed as a medically approved alternative to opioid therapy. Therapeutic massage can also be used to help reduce cancer-related pain, fibromyalgia symptoms, and stress-related symptoms of heart disease.
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 therapist’s 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.
How Does Medicare Cover Massage Therapy?
Original Medicare (Part A and Part B) doesn’t cover massage therapy. As such, if you receive therapeutic massage services from a massage therapist in the hospital or in an outpatient setting, you will be responsible for 100% of the costs.
In contrast, therapeutic massage services provided by a physical therapist as part of a medical treatment plan are typically covered by Part B. The distinction seems small, but it’s important for Medicare purposes.
If you get massage therapy as part of physical therapy, Part B pays 80% of allowable charges after you meet your Part B deductible.
If your Medicare Advantage plan covers massage therapy, it’s important to find out how the benefit is handled.
Medicare Supplement Plans And Massage Therapy
A Medicare Supplement plan (also known as Medigap) pays your out-of-pocket costs under Part A and Part B. If a service is covered by Original Medicare, it’s also covered by your Medigap plan. All Medigap plans pay some or all of your Part B coinsurance.
In other words, if you get massage therapy from a licensed physical therapist, your Medigap plan will cover your share of the charges. In contrast, if you are treated by a massage therapist, your treatment isn’t covered by Medigap.
Do Medicare Advantage Plans Cover Massage Therapy?
Even though Medicare Advantage is offered by private insurance companies, these insurers still must provide all the same benefits as Original Medicare at a minimum. In many cases, they offer extra benefits to their members.
This works to your advantage because plans have to compete for members. If a plan offers benefits that appeal to a large number of Medicare beneficiaries, they stand a better chance of enrolling new members. That’s why so many Medicare Advantage plans go above and beyond to provide coverage for routine vision, dental, and hearing care, even though those services aren’t covered by Original Medicare.
This is also the reason why some Medicare Advantage plans include benefits for massage therapy. As massage therapy grows in popularity and gains acceptance in the medical community, more people look for health plans that cover it.
Understanding Massage Therapy Benefits
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 aren’t 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, it’s important to find out how the benefit is handled. You should also ask about any coverage restrictions that may apply. Some plans require a doctor’s order and proof of medical necessity. Others may only pay for services with certain massage therapy providers.
Massage Therapy And HSAs
If you have a health savings account (HSA), 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 doesn’t 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 doesn’t 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, you’ll avoid any unpleasant surprises at billing time.