Insurance Billing

Many clients and referred patients have inquired about massage therapy being covered by insurance and if it is accepted. Some health insurance plans do cover massage therapy. Often times a provider of massage therapy needs to be an in network insurance participating provider to be a covered service. At this time Medicare/medicaid and most VT based health insurance plans do not recruit massage therapists. However it has been my experience that health care insurance covers this only when administered by a health care provider such as a clinician, physical therapist, chiropractic physician or naturopathic physician when part of a medically necessary treatment protocol of a specific injury or diagnosed medical condition. Employer Group Health Insurance benefits often cover massage under certain guidelines through a Health Savings Account/Flexible Spending Account, sometimes without a prescription. It is the responsibility of the individual to provide any forms needed to be filled out by the massage therapy provider after treatment visit. You may need certain credentialed therapist information indicated on reimbursement forms. If your health insurance plan specifically covers massage therapy with a massage therapist provider and you are interested in massage reimbursement, find out if it is a covered service when administered by a massage therapist. If it is, you can get a prescription for massage therapy of a specific condition or injury in which it is a medical necessity. Advanced Nurse Practitioners, DPT-Physical Therapists, Medical Doctors/Physicians (Including DO-Doctor Of Osteopathic Medicine) and Supervised Physicians Assistants can prescribe a medically necessary/indicated massage treatment for their patients. A receipt of service and treatment notes are provided for you to seek reimbursement. Personal injury protection/PIP Insurance such as automobile/medical benefits often cover massage therapy when administered by a massage therapist related to a MVA (Motor Vehicle Accident). Remember that they will only cover the massage superbill/HCFA-1500 claim when there are adequate funds left in the medical benefits policy and have the correct ICD-10 codes provided by your PCP or other prescribing health care provider. You would need to get prior authorization from the claim adjuster representative, a prescription for massage therapy of a specific injury/medical condition, indicating an ICD-10 diagnosis code. The referred patient can submit directly to the insurance provider for reimbursement or it can be billed directly by the Massage Therapy Practitioner directly. Workers compensation is often covered when administered by a massage therapist, with all of the proper documentation needed. Remember to seek treatment within a year before your case is closed. More details are given of specific information needed upon appointment and massage treatment visit.