Did you know most major medical insurances do cover massage therapy? However in most cases you must meet your insurance carriers “Clinical Review Criteria”. Kaiser Permanente for instance does offer its providers and customers access to their notice to Clinical Review Criteria on Washington plans. This explains the rules that Kaiser Permanente has set in order for them to cover massage therapy services for their customers.
When accessing your insurance plans massage therapy coverage information, please be sure to verify coverage per plan. And understand your medical insurance “reserves the exclusive right to modify, revoke, suspend or change any or all of these Review Criteria” at their “sole discretion, at any time, with or without notice” to you or your provider.
In almost all cases massage therapy is NOT covered by medical insurance, if it is provided for prevention, recreation, or stress reduction. If it is directed at the maintenance of current levels of function. Or you the patient has achieved a therapeutic goal set by you and your provider, or are not showing “meaningful progress”.
This means NO preventive care should be billable to your insurance. This also means if you are receiving massage therapy regularly without documentation that the complaint you have made, (the reason you received a prescription), is not getting better, over a reasonable amount of time; your insurance has the right to suspend care and revoke payment. This would leave YOU the patient responsible to pay for all services rendered.
So be sure you know your insurance carriers rules if you plan of having them pay for your massage therapy care. All medical insurances will also required a prescription or referral from your medical doctor. This must include a valid diagnosis. Some insurance companies regularly deny billing with diagnosis codes they have deemed massage therapy ineffective for. IE: HMA insurance and code G43109 Migraine with aura, not intractable, without status migrainosus. This is NOT a code they are willing to accept as valid for massage therapy (per billing in 2018 abd 2019, subject to change). Your primary care or referring physician will always be the provider to decide what code your massage therapist will be billing under. Diagnosing a patient is out of the scope of practice for all Washington State Massage Therapists, without exception. And ALL medical insurances require a diagnosis to accept a billing.
So, please know your insurance carriers rules prior to scheduling your massage; if you plan of having it billed to your medical insurance.
We are always happy to help if you have any questions or concerns.