Can You Use an HSA for Massage Therapy?

Health Savings Accounts (HSAs) offer a tax-advantaged way to save and pay for qualified medical expenses. Available to individuals enrolled in a high-deductible health plan (HDHP), HSAs allow pre-tax contributions, tax-deferred growth, and tax-free withdrawals for eligible healthcare costs. Not every health-related service or product automatically qualifies for reimbursement. Proper substantiation is required to ensure compliance with Internal Revenue Service (IRS) regulations.

What Makes a Massage an Eligible Expense

For massage therapy to be an eligible Health Savings Account (HSA) expense, it must meet the IRS definition of “medical care.” This means the massage must be for the diagnosis, cure, mitigation, treatment, or prevention of a specific disease, or for affecting any structure or function of the body. General wellness, relaxation, stress reduction not tied to a diagnosed condition, or cosmetic purposes do not qualify.

A licensed healthcare provider, such as a physician, chiropractor, or physical therapist, must diagnose a specific medical condition and then prescribe or recommend the massage therapy as a direct treatment for that condition. This medical necessity is crucial for the expense to be eligible. Without a direct link to a diagnosed illness or injury, the massage cannot be paid for with HSA funds.

The recommendation from the healthcare provider comes in the form of a “Letter of Medical Necessity” (LMN) or a formal prescription. This document must clearly state the patient’s specific medical condition, the type of massage therapy needed, the recommended frequency, and the duration of the treatment. Conditions such as chronic back pain, fibromyalgia, specific injuries, or migraines are examples where massage might be deemed medically necessary.

Essential Documentation for Reimbursement

To substantiate massage therapy as a qualified medical expense, two types of documents must be obtained and retained. The first is a Letter of Medical Necessity (LMN) or prescription from a licensed healthcare provider. This document confirms the medical necessity of the massage therapy for a specific diagnosed condition.

The LMN or prescription must contain specific information. It should include the patient’s full name, the specific medical diagnosis, and a detailed description of the prescribed massage treatment, including the recommended frequency and duration. The document also requires the healthcare provider’s name, signature, date, and license number.

The second document is a detailed receipt from the massage therapist or facility. This receipt serves as proof of payment and service delivery. It must clearly show the date of service, a description of the service, the total amount charged, and the name and address of the massage therapist or facility. The patient’s name should also be on the receipt.

Maintaining these records is important, even if you pay directly with an HSA debit card. The IRS requires substantiation for all qualified medical expenses, and these documents are necessary in case your HSA administrator requests verification or if your account is audited. Proper record-keeping ensures compliance and can prevent potential penalties for unsubstantiated withdrawals.

How to Use Your HSA for Qualified Massages

Once medical necessity and documentation are obtained, you can use HSA funds for qualified massage therapy. There are two methods for payment. If the massage therapist or facility accepts HSA debit cards, this is a direct payment option.

When using an HSA debit card, the transaction may be automatically substantiated by the system, especially if the provider uses an Inventory Information Approval System (IIAS). However, it is important to keep all documentation, including the LMN and detailed receipts, for your personal records. This ensures you have the necessary proof of eligibility in case of a future review or audit by the IRS.

Alternatively, you can pay for the massage therapy out-of-pocket and then seek reimbursement from your HSA. This process involves submitting a claim to your HSA administrator, often through an online portal or by mail. When submitting a reimbursement claim, attach copies of both the Letter of Medical Necessity and the detailed receipt as supporting documentation.

Regardless of the payment method, maintaining thorough records is an ongoing requirement. These records are essential for tax purposes and to substantiate claims if requested by the IRS. Keeping all LMNs, prescriptions, and detailed receipts organized ensures your massage therapy expenses meet IRS criteria for qualified medical expenses.