Massage therapy may be covered by your Premera Blue Cross plan when your condition is considered to be medically necessary.
All plans require a prescription from a doctor. The insurance company representatives will often say that it is not required. As a massage therapist, I am not allowed to diagnose conditions so a diagnosis needs to come from a doctor in order for your sessions to be covered by insurance.
The prior authorization is done through a 3rd party hired by Premera called eviCore. The PA has to be done within 7 days after your 1st visit. I take care of this process. What it means is that I take the prescription and your plan details and plug them into eviCore's website and they will tell me how many sessions you can get for your massage therapy. This ignores your plan benefits and the doctor's prescription. What usually happens is that they approve an initial 4 sessions no matter what your condition is. After the 4 sessions have been completed, I can sometimes request more sessions and they usually will approve 2-3 sessions depending on their computer system.
What this means is that even though your insurance may allow 16 sessions and your doctor prescribes say 10 sessions or even the full 16 sessions, you get 4-6 sessions.
Amazon.com employees and Microsoft employees are exempt from the prior authorization process, but a prescription is still required.
Premera’s Medical Policies Bulletin states:
https://www.premera.com/medicalpolicies/8.03.502.pdf (Accessed 05/10/2017)
Physical medicine and rehabilitation —physical therapy (PM&R –PT), including medical massage therapy services —may be considered medically necessary when ALL of the following criteria are met:
PM&R PT and/or medical massage therapy services must be described using standard and generally accepted medical/physical/massage therapy/rehabilitation terminology. The terminology should include objective measurements and standardized tests for strength, motion, functional levels and pain. The plan should include training for self management for the condition(s) under treatment. Services provided that are not part of a therapy plan of care, or are provided by unqualified staff are not covered.
Medical massage therapy
Medical massage therapy may be considered medically necessary as the only therapeutic intervention when ALL of the above criteria for physical medicine and rehabilitation —physical therapy (PM&R –PT)are met
The diagnosis specific prescription, from the attending clinician with prescribing authority, stating the number of medical massage therapy visits is retained in the member’s massage therapy medical record.
The diagnosis-specific plan of care, approved by the attending clinician with prescribing authority, is retained in the member’s massage therapy medical record