Massage therapy has long been associated with relaxation and spa treatments, but in recent years, it has gained recognition as a legitimate healthcare service. Many clients seek coverage for medical massage therapy under their health insurance plans, but reimbursement isn’t always straightforward. This guide will help you understand the differences between general and medical massage therapy, how to verify insurance coverage, and what to do if services aren’t covered.

Medical massage therapy versus general massage therapy

Once considered a luxury service, massage therapy is now recognized as part of complementary and alternative medicine (CAM). According to the CDC, 23.5% of adults have had at least one expenditure for a CAM care approach within a 12-month period.

Medical massage therapy differs from general massage therapy because it is tailored for specific medical conditions. It is designed to treat injuries, improve function, and enhance circulation as part of a structured treatment plan. As more providers incorporate medical massage therapy into their care plans, many clients seek insurance coverage to help with costs. However, getting insurance reimbursement requires careful navigation of payer requirements.

How to accept insurance for medical massage therapy

Despite its proven benefits, massage therapy is often classified as an alternative treatment, making it ineligible for coverage under many insurance plans. In this blog, we outline the strategies to improve the chances of obtaining insurance reimbursement.

Physician Referral

One of the most effective ways to secure insurance coverage for massage therapy is to obtain a physician referral. Since massage therapists are not licensed to diagnose medical conditions, a physician referral with an ICD-10 diagnostic code increases the likelihood of insurance reimbursement.

Some insurance companies also require providers to obtain pre-authorization before offering services. Additionally, coverage varies by state. While all 50 states reimburse for massage therapy related to workplace injuries or motor vehicle accidents, some states extend coverage to physician-prescribed services.

Insurance Verification

Coverage for medical massage therapy depends on how the treatment is classified by the insurance company. If it is deemed medically necessary or falls under “habilitative or habilitation treatment,” it may be covered as an essential health benefit. However, many insurers only consider massage therapy necessary during the acute phase of treatment, rather than as an ongoing therapy.

To ensure proper coverage, verify your client’s benefits before providing services. Key questions to ask include:

• What conditions qualify for reimbursement?
• Will there be a deductible or out-of-pocket cost?
• Is there a limit on the number of covered visits?
• Are certain body regions excluded from coverage?
• Do all types of massage therapy qualify?

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CPT codes for medical massage therapy

If insurance coverage is available, you’ll need to use the correct CPT codes for billing. The primary codes for medical massage therapy include:

• CPT code 97124 – Therapeutic Massage: This code is used for therapeutic massage to treat musculoskeletal pain or injury, including soft tissue mobilization and other techniques to improve circulation and decrease muscle tension.
• CPT code 97140 – Manual Therapy Techniques: This code may be used for therapeutic interventions that involve manual techniques (e.g., massage, mobilization, and manipulation) to reduce pain and restore function.
• CPT code 98940 – Chiropractic Manipulative Treatment (CMT): While not a traditional massage therapy code, this is sometimes used in conjunction with massage for spinal manipulation treatments.
• CPT code 97112 – Neuromuscular Reeducation: If massage therapy is used in conjunction with neuromuscular reeducation, this code could be appropriate.
• CPT code 97750 – Physical Performance Test: In some cases, massage therapy may be considered part of a broader physical performance test and used in combination with other therapeutic techniques.

Comparing CPT code 97124 and 97140

As the two most commonly billed massage therapy CPT codes, it is important to understand the difference between codes 97124 and 97140. 

CPT Code 97124 is specifically for massage therapy, encompassing techniques such as effleurage, petrissage, and tapotement. This code is billed in 15-minute increments.

CPT Code 97140 is for manual therapy techniques, including joint mobilization, manipulation, manual lymphatic drainage, and manual traction. Like 97124, it is also billed in 15-minute increments. 

While massage therapists might argue that there can be an overlap in treatment within these two CPT codes, it is important to note that these two codes cannot be billed together for the same session, as insurance companies will usually not cover both simultaneously.

What to do if services are not covered

If you find that insurance won’t reimburse for medical massage therapy, consider alternative payment options to make services accessible to clients. Alternative payment models could include: 

Accept an HSA/FSA card

Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) allow clients to use pre-tax dollars for qualified medical expenses, including medical massage therapy. This method enables providers to receive full payment while helping clients avoid out-of-pocket expenses.

Offer service packages at a discounted rate

Bundling sessions into a package at a discounted rate can make massage therapy more affordable. For example, instead of charging $100 per session, offering a five-session package for $425 can incentivize clients to commit to ongoing care while ensuring consistent bookings.

Provide a Superbill

A Superbill is a detailed receipt that clients can submit to their insurance company for potential reimbursement. While it does not guarantee coverage, it provides clients with a formal request for reimbursement based on medical necessity.

Payment Plans

Payment plans can make services more accessible to clients struggling to pay for treatments upfront. By allowing clients to spread payments over time, you can increase affordability while maintaining a steady revenue stream. If managing payment plans directly is not feasible, you might consider accepting third-party financing options. Third-party healthcare financing options such as CareCredit or ClearGage allow clients to pay for services over time while ensuring you receive full payment upfront. 

Affiliate with an insurance company

Some insurers allow massage therapists to affiliate with them, meaning clients won’t receive direct coverage but can access discounted services at affiliated providers. This arrangement can increase referrals and client volume.

How Healthie supports massage therapists

Healthie’s all-in-one platform helps massage therapists streamline their administrative tasks while optimizing insurance reimbursement processes. Key features include:

✔️ Insurance billing: Generate CMS-1500 claims, track claim statuses, and invoice clients for non-covered amounts.

✔️ EHR System: Healthie’s HIPAA-compliant electronic health record helps you securely track client progress. 

✔️ Packages and Invoices: Create custom service packages and process payments using Stripe integration. 

✔️ Online Booking: Set up custom appointment types and schedule clients with ease.

✔️ Client Engagement: Stay connected with clients using Healthie’s HIPAA-compliant chat feature.

Healthie simplifies practice management, allowing massage therapists to focus on providing quality care. With the right approach, medical massage therapy can be both financially viable for clinicians and accessible to clients.