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.
As of June 7, 2018, prior authorization is no longer required for your first 6 sessions. After your 6 sessions are completed, more sessions can be requested as required through eviCore, the third party prior authorization company. They usually will allow a few more sessions depending on your condition. It does not matter what your doctor has prescribed.
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.
Massage therapy must meet medical necessity directives outlined by your health insurance plan. Below are the policies for Premera Plans. Check your own plan for further confirmation.
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