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Insurance Coverage for Massage Therapy

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

ALL Plans require that massage therapy be medically necessary and each plan has their own specific definition of what that means. Check your policy.  Here are some sample definitions of medical necessity.

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. A prescription is different from a referral.  Some plans will say that you do not need a referral, but you still will need a prescription.  A prescription will provide a diagnosis code and a treatment plan stating the number of sessions the doctor is prescribing and the duration. (Example: 1x a week for 6 weeks)

You will be allowed 6 sessions to be completed without prior-authorization. After that, your insurance requires that I obtain a prior-authorization from a company they have hired called eviCore, before completing more sessions.

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.

Some of the conditions that massage can help and that your health insurance will cover are:

  • Carpal Tunnel Syndrome
  • Frozen Shoulder
  • Headaches (some limits may apply)
  • Herniated Discs
  • Jaw pain
  • Muscle strains/sprains
  • Muscle Pain that causes loss of movement: Back, neck, hips, knees, feet
  • Plantar Fasciaitis
  • Recovery from surgery like hip/knee/shoulder replacements

Use this handy insurance verification form (PDF) if you call your insurance to investigate your massage therapy benefits.