Medicare and Medicare Advantage plans are the primary insurance providers for approximately 68 million Americans. Original Medicare plans (Parts A and B) do not generally cover massage therapy as they consider it to be an “alternative and complementary medicine” practice and thus not medically necessary. That said, if massage therapy (or manual therapy as it is often called) is part of a broader physical therapy or occupational therapy plan of care, it may be covered when rendered by an approved provider.
Alternatively, Medicare Advantage Plans (Part C) are administered by private insurers and may cover massage therapy as an additional benefit depending on your plan. For massage to be covered, it likely needs to be prescribed by a healthcare provider for a specific condition, performed by a licensed massage therapist who is in the plan’s network, and determined to be primarily health-related rather than for overall relaxation.
Medicare options
Medicare is the U.S. government’s largest insurance program. It primarily covers beneficiaries who are 65 and older but may cover younger individuals who have disabilities or other specific conditions. Medicare is often described by its ‘parts.’
Part A covers inpatient hospital stays, skilled nursing facility and hospice care as well as some home health services.
Part B is used for outpatient care including physician visits, preventative care such as flu shots or mammograms, durable medical equipment, and physical, occupational, or speech therapy. Covered services must be provided by a participating provider; non-participating providers are prohibited from providing medically necessary services to Medicare beneficiaries and should refer these individuals to participating providers.
Pros: Original Medicare is widely accepted and does not have network restrictions. Costs are predictable and coverage is robust.
Cons: No cap on out-of-pocket costs (insured party is responsible for 20% of covered services), no coverage for routine dental, visual, hearing, or alternative therapies such as massage therapy.
Part C, known as Advantage plans, are alternative plans offered by private insurers but have been approved by Medicare. Part C plans typically combine Parts A, B, and D and may have additional benefits, such as dental, vision, or massage coverage.
Coverage of massage therapy as a standalone service varies by plan but may be available with a prescription from an appropriate healthcare professional when provided by a licensed therapist within the plan’s network. Part C plans must cover everything that traditional Medicare covers along with the additional benefits.
Pros: Out-of-pocket costs may be lower, all-in-one coverage for “extra” services like massage, dental, and vision.
Cons: Provider networks may be restrictive, coverage varies widely by plan/region, and potential for higher costs for out-of-network care.
Why doesn’t most insurance cover massage therapy for chronic pain conditions?
Most insurance providers do not cover massage therapy for chronic pain conditions because it is considered an “alternative” or “complementary” therapy rather than a medically necessary treatment. Generally speaking, massage therapy lacks robust evidence of its effectiveness which is what insurers look to when deciding which services are covered.
Treatments that have strong scientific support from randomized controlled trials tend to be more cost-effective and thus are more likely to be covered. The evidence surrounding the use of massage therapy is often promising while also being inconsistent or insufficient by insurance standards.
Compared to studying interventions like those for rotator cuff tears or knee arthritis, researching massage therapy is more difficult because it’s harder to gather enough participants for a statistically powerful study, ensure enough consistency to be generalizable, or collect sufficient long-term data to show clear effects.
Also, cost may be a factor when it comes to chronic pain. According to the Centers for Disease Control, chronic pain affects more than 68 million adults in the U.S.. Covering massage therapy for a condition that affects 20% of the population could get quite costly—particularly for an intervention without clear evidence that it reduces overall healthcare costs, such as fewer surgeries or medications.
Insurers prefer interventions with predictable outcomes over interventions, like massage, that lack standardized dosing and vary widely by provider.
The fine print
Purchasing insurance—even through payroll deductions over a 40-year career—creates a contract between you and the insurer. Understanding the terms of that contract can make navigating the healthcare system much less frustrating.
Massage therapy is covered when it is provided by a physical or occupational therapist, but not when performed by a licensed massage therapist. (Photo courtesy of Zach Smith, photo by Eric Hutchinson of Dreamlapse Studios)
While Medicare offers comprehensive coverage, it’s not all-inclusive. There are specific limitations on which services are covered and who is authorized to provide them. For example, it may be confusing that massage therapy is covered when provided by a physical or occupational therapist, but not when performed by a licensed massage therapist. Ultimately, it comes down to the terms of your agreement with Medicare and its definitions of covered services and qualified providers.
Examples
When massage is part of a broader plan of care, it can be covered by Medicare. For instance, if you are in physical therapy for a rotator cuff tear, the therapist may determine that massage is medically necessary to address compensatory tightnesses in your neck and shoulder.
At this point, the physical therapist (or a physical therapist assistant) can provide massage therapy that will be covered by Medicare. This type of treatment can continue until the physical therapist determines that the massage is no longer medically necessary.
Conversely, if several visits later you see the same physical therapist and ask for a neck massage because you have had a stressful day, they will tell you this is not a service Medicare will cover. Even though the massage would feel nice and likely would lead to decreased stress, Medicare would not cover massage in this situation because there is no medical necessity for the intervention.
At this point, the physical therapist may ask you to sign an Advanced Beneficiary Notice (ABN) if you choose to receive a massage. An ABN is a form that providers are required to give before delivering a service that Medicare is expected to deny. By signing the ABN, you acknowledge that you will likely be responsible for the full cost of the service and agree to pay out of pocket.
Massage therapy
Massage therapy is typically defined as the practice of manipulating soft tissues— muscles, tendons, ligaments, and fascia— through specific technique, or strokes, that promote relaxation, relieve pain, and improve overall well-being.
Massage therapy also dims the response of the sympathetic nervous system (fight or flight) and activates the parasympathetic nervous system (rest and digest) which leads to generalized reduction in stress and tension.
Also, massage can lower the presence of the stress hormone cortisol while increasing the presence of serotonin and dopamine, which improve mood and relaxation. Massage therapy may also alter pain sensitivity by stimulating nerve endings and releasing your body’s natural painkillers, endorphins, which may decrease chronic pain signals over time.
Five of the most common types of massage therapy are:
- Swedish massage uses a gentle, flowing style using long strokes, kneading, and circular motions to improve circulation and promote general relaxation. Swedish massage can be very rhythmic which is soothing to the nervous system.
- Deep tissue massage targets deeper muscle layers and fascia with slow, firm pressure to release chronic tension. Deep tissue massage may be quite painful at the moment, but ultimately leads to reduced pain sensitivity and improved motion as muscle tension is decreased.
- Lymphatic massage or manual lymphatic drainage uses light, rhythmic strokes to stimulate the lymphatic system which may reduce swelling. This massage can also calm the nervous system and support hormonal balance through increased fluid movement which helps with pain from chronic inflammation.
- Sports massage uses a combination of techniques, such as deep kneading, compression, friction, and joint mobilization to prepare for competition, enhance flexibility, reduce the risk of injury, and speed recovery. Sports massage is often used prior to activity to warm up the body, during events or address acute tightness, or post-exercise to reduce soreness and lactic acid build up.
- Myofascial release is a slow, gentle approach that applies prolonged pressure to stretch and loosen the fascia, which allows for improved mobility and less pain. Relieving the structural stress of stiff fascia can quiet the nervous system and improve the balance of cortisol and dopamine/serotonin.
Takeaway
Medicare typically excludes standalone massage therapy under Parts A and B unless it’s part of a broader, prescribed physical or occupational therapy plan. Some Medicare Advantage programs may cover it if deemed medically necessary and provided by an in-network licensed massage therapist.
Most insurance plans don’t cover massage therapy for chronic pain due to insufficient evidence and high costs, and despite its ability to reduce pain and stress, there’s no clear link to lower overall healthcare expenses, leaving insurers without incentive to include it.
Penny Goldberg, DPT, ATC
Penny Goldberg, DPT, ATC earned her doctorate in Physical Therapy from the University of Saint Augustine and completed a credentialed sports residency at the University of Florida. She is a Board Certified Clinical Specialist in Sports Physical Therapy.
Penny holds a B.S. in Kinesiology and a M.A. in Physical Education from San Diego State University. She has served as an Athletic Trainer at USD, CSUN, and Butler University.
She has presented on Kinesiophobia and differential diagnosis in complicated cases. Penny has published on returning to sports after ACL reconstruction and fear of movement and re-injury.
Outside of the clinic, Penny enjoys traveling, good cooking with great wine, concerts, working out and playing with her dogs.
