How to Talk to Your Physician About Massage Therapy
For millions of people dealing with joint or muscle conditions or a variety of other conditions and illnesses, massage can be an effective type of treatment or an important part of the overall treatment plan. The American Massage Therapy Association (AMTA) found that 78% of those surveyed in their 2020 consumer research report, stated that the reason for their last massage was 52% medical and 26% stress related (1). However, despite the increase of massage related research demonstrating the many benefits, quite a few insurance companies often consider massage to be an elective treatment. As a result, visits to a massage therapist will often not be covered by medical insurance unless the patient obtains a referral from their physician (2). Specialists in many different fields are more often referring their patients for massage therapy. In fact, national research from the AMTA has shown that 24% of the patients who spoke to their physician about massage received strong recommendations to receive massage (1). Doctors who have taken the time to learn about massage often refer their patients who could benefit from this type of treatment. For those who want to obtain a medical massage referral with the goal of getting massage visits covered by insurance, please find some considerations herein.
CHECK YOUR INSURANCE RULES
Health care rules and regulations are “continually evolving, standards vary from state to state and from insurance company to insurance company” (2). Some insurance companies do not cover massage even when prescribed by your physician, so first and foremost, before asking your physician for a massage referral, you should check with your insurance provider to find out whether massage therapy is a coverable service under your specific insurance plan.
If massage is covered, you will next want to be aware of any exclusions or limitations. Get clarification on whether massage is coverable when administered by a massage therapist. Some plans require that massage be performed by a physical therapist or within a physicians office.
WHO REFERS
Providers that typically refer for massage include:
Physical Therapists
Chiropractors
Medical Physicians, such as General Practice, Orthopedic, Osteopathic, and OBGYN doctors
Mental Health Professionals
Dentists
UNDERSTAND THE BENEFITS OF MASSAGE
Be a proactive participant in your health care. Not all physicians are familiar with the many benefits of therapeutic massage, so you will want to research the possibility that massage therapy is a good choice for treatment for your particular condition(s). If it is not a well-known or recognized treatment for your condition or injury, your doctor may be hesitant to give you the go-ahead to pursue massage therapy as a prescribed treatment. There are many conditions for which research has found massage therapy to be beneficial, including pain (e.g. back, neck, headache, carpal tunnel, post-operative, fibromyalgia, arthritic pain), muscle tension, stress relief, improved sleep, improved blood pressure, increased range of motion, improved quality of life (3).
TALK TO YOUR PHYSICIAN
Talk to your doctor about your symptoms and the available treatments that may help you cope and/or recover from your condition(s). It is possible that your doctor will suggest other therapies such as physical therapy and/or medication before suggesting massage, so you may need to bring it up yourself. Explain why you would like to include therapeutic massage as part of your treatment plan. In order to prove medical necessity for massage, you must have a recognizable health condition that may respond to massage therapy so it is important to be aware of any documentation indicating the benefit of massage for your condition(s). Many resources can be found under the services menu on the Journey to Wellness website related to each type of treatment offered.
Allow your doctor to express any concerns and reservations in prescribing massage treatment. Ask the doctor about what kinds of other treatments go along with therapeutic massage. One way to get a better chance of successful coverage is to combine therapeutic massage with other types of treatments. The research does indicate in some cases that a combination of holistic treatments may provide the most benefit for some conditions. Ask about how a holistic treatment plan can help provide better rehabilitation or recovery while legitimizing the use of therapeutic massage. In some cases your physician may only sign off on a massage referral along with other treatment options. If your doctor refuses to approve massage for insurance, ask for a referral for a second opinion. If he agrees, wait for him to write a prescription for massage, and then send the authorization to your insurance company along with your massage receipts for reimbursement.
Each session of massage therapy you receive will require a valid and current referral. Typically, depending on what your insurance company requires, your referral must must include your treatment start date, number of visits prescribed by your physician, frequency of sessions, and diagnosis codes referencing your injury or condition. The diagnosis codes are the most important part of your referral because you need them to claim the massage therapy sessions with your insurance company. A massage therapist is not a physician and therefore cannot provide you with diagnosis codes, this must come from your referring physician.
TALK TO YOUR MASSAGE THERAPIST
Many massage therapists are trained in specific massage techniques. You should ask the therapist what types of techniques they offer and discuss a treatment plan that is right for your injury or condition.
Not all massage therapists are able to directly bill for services, so you may have to claim the therapy yourself through your insurance company. Journey to Wellness, Inc currently does NOT bill insurance directly but we are able to provide you with a detailed receipt that will include your name, dob, the providers license, NPI, and tax ID, providers address, treatment codes, and cost of treatment received.
This receipt along with a copy of your medical massage referral with diagnosis codes from your physician should allow your session to be considered a medical necessity, and more likely covered by your insurance provider.
RESOURCES
Consumer Views and Use of Massage Therapy. Based on the American Massage Therapy Association 2020 Massage Profession Research Report. https://www.amtamassage.org/publications/consumer-views-use-of-massage-therapy/ [Accessed 10/25/20].
Insurance Reimbursement. American Massage Therapy Association. https://www.amtamassage.org/resources/business-financial-tools/insurance-reimbursement/ [Accessed 10/25/20].
25 Reasons to Get a Massage. American Massage Therapy Association. https://www.amtamassage.org/find-massage-therapist/25-reasons-to-get-a-massage/ [Accessed 10/25/20].
