Can You Use Flex Spending for Massage Therapy?

A Flexible Spending Account (FSA) is an employer-sponsored benefit that allows individuals to set aside pre-tax money from their paycheck to cover eligible healthcare costs. This provides a tax advantage for out-of-pocket medical, dental, and vision expenses. While massage therapy is not automatically covered, it can be an eligible expense under specific conditions, primarily when deemed medically necessary. This article clarifies when massage therapy qualifies for FSA reimbursement and the required steps for coverage.

Understanding Flexible Spending Accounts

Flexible Spending Accounts are tax-advantaged arrangements allowing employees to contribute pre-tax salary for qualified medical expenses for themselves, their spouse, and dependents. This helps individuals manage healthcare costs.

FSAs have a “use-it-or-lose-it” rule, meaning unspent funds at year-end are typically forfeited. Employers may offer a grace period of up to two and a half months, or a carryover option for up to $660 of unused funds into the next year for plan years ending in 2025. Employers can offer one of these options.

When Massage Qualifies as a Medical Expense

For FSA reimbursement, massage therapy must be medically necessary. The Internal Revenue Service (IRS) defines medical care as amounts paid for the diagnosis, treatment, or prevention of disease, or for affecting any body structure or function. This means massage must directly address a specific medical condition or injury, not general relaxation or wellness.

Massage therapy may qualify if prescribed by a licensed medical professional for conditions such as chronic back pain, carpal tunnel syndrome, muscle strains, or post-surgical recovery. Other examples include anxiety or stress-related disorders, arthritis, migraines, and sciatica, provided the massage is part of a treatment plan for these diagnosed conditions. The medical professional must deem the massage essential to the treatment or recovery.

Required Documentation for Reimbursement

To claim massage therapy reimbursement from an FSA, a Letter of Medical Necessity (LMN) is required. This written statement from a licensed medical professional, such as a physician, chiropractor, or physical therapist, verifies the medical need for the massage therapy. The LMN must state the patient’s diagnosis and explain how massage therapy is a necessary part of the treatment plan for that condition.

The letter should detail the recommended treatment plan, including frequency and duration of sessions, and how massage will alleviate the diagnosed condition. An LMN is typically valid for up to one year. In addition to the LMN, detailed receipts from the massage therapist are necessary, showing the date of service, description of the service provided, the cost, and the therapist’s credentials.

The Reimbursement Process

Once massage therapy sessions have been received and all required documentation is gathered, the next step is to submit a claim to the FSA administrator for reimbursement. Most FSA providers offer multiple submission methods, including online portals, mobile applications, or mail. When submitting, individuals will typically need to input basic information about the claim, such as the amount, the provider’s name, the date of service, and who received the service.

Supporting documentation, including the Letter of Medical Necessity and the itemized receipts, must be uploaded or attached to the claim. It is important to ensure that images of documents are clear and legible. After submission, the FSA administrator will process the claim, which typically takes between two to four business days for approval. Reimbursement funds are generally disbursed within two to four business days via direct deposit or seven to ten business days if a paper check is issued.