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Insurance Coverage for Massage Therapy

I accept Regence Blue Shield and Premera Blue Cross insurance plans.

All Regence Blue Shield require a prescription and must be medically necessary.  Most plans require a prior authorization. Be sure you read the full page on this.  

ALL Premera Blue Cross require a prescription from your doctor and must be medically necessary.  Most plans also require prior authorization.  Please read the page on Premera Blue Cross.

All insurance claims must have a prescription from your doctor with a diagnosis in order to be processed, no matter what the insurance company says.  Insurance will only cover massage if there is an injury or condition that makes it medically necessary to get a massage. It does not cover massage just for stress. It does not cover maintenance or preventative massage. It does not cover soreness due to exercise. It will cover things like herniated discs, carpal tunnel syndrome, plantar fasciaitis and tennis elbow. Please call your insurance company to find out what your benefits are. Ask for the medical necessity definition.

 Your Health insurance may cover your massage therapy services if you are dealing with a specific injury or condition that can be resolved or improved by getting massage therapy - in the insurance companies words it must be "medically necessary" and the massage sessions must show improvement in your condition.  Insurance does not cover massage for your convenience and does not cover massage for the purpose of wellness or maintenance.   Maintenance massage would be coming in once a month or 2x a month.

Medically necessary massage means that you will be coming in once or twice a week to help heal an injury or condition. It works more like physical therapy in that there is an end date.

Medically necessary treatment is usually defined something like this (READ Your own policy to find out what it means for you):

"Massage therapy may be considered medically necessary when performed to meet the functional needs of a patient who suffers from physical impairment due to disease, trauma, congenital anomalies, or prior therapeutic intervention. Maintenance programs are considered not medically necessary."

Please check with your insurance company to get your definition of medically necessary as the definitions will vary with each company and to find out what your policy allows for as far as getting massage therapy.

Most Regence Blue Shield and Premera Blue Cross plans require prior authorization.  This is a process that I complete through a third party company called eviCore that will tell me how many sessions you will be able to get through your insurance. They preauthorization process will limit the number of sessions allowed.  The initial request usually allows approximately 4 sessions.  An additional request may allow anywhere from 1-4 sessions of additional care depending on how much improvement has been shown and how much more is needed.   

There must be a loss of function in one area of daily living activities (sitting, standing, walking, stair climbing, lifting, working, personal care (washing/dressing), driving, sleeping.)  There must also be a subjective complaint of pain in some area of the body.

Services for any condition with minimal pain levels and/or functional deficits that can be self managed are NOT covered.

For complete information, please see the Clinical Guidelines from eviCore. (PDF)