Can You Use Your HSA for a Massage?

Health Savings Accounts (HSAs) offer a tax-advantaged way for eligible individuals to save and pay for qualified medical expenses. These accounts are designed to help people manage healthcare costs by providing a triple tax benefit: tax-deductible contributions, tax-free growth, and tax-free withdrawals for eligible expenses. A common question arises regarding the eligibility of various health-related services, including massage therapy, for HSA reimbursement.

Eligibility of Massage Therapy as an HSA Expense

For massage therapy to be considered an eligible expense for HSA reimbursement, it must meet the Internal Revenue Service (IRS) definition of “medical care.” This means expenses must be primarily for the “diagnosis, cure, mitigation, treatment, or prevention of disease, or for affecting any structure or function of the body.” Therefore, the massage must be prescribed to treat a specific medical condition, not for general wellness or relaxation.

Massage therapy may qualify as a medical expense if recommended by a licensed medical professional, such as a physician, chiropractor, or physical therapist, to alleviate a diagnosed medical condition. Examples include chronic back pain, fibromyalgia, carpal tunnel syndrome, or post-operative recovery. The treatment must directly address a health issue, aiming to improve a specific bodily function or reduce symptoms.

Therapeutic massage for a medical condition must be distinguished from massage for general well-being. Massage for relaxation, stress reduction not linked to a diagnosed medical condition, or general health improvement typically does not meet IRS criteria. The primary purpose must be remedial, not for pleasure or general physical conditioning.

Documenting Medical Necessity

To substantiate the medical necessity of massage therapy for HSA reimbursement, individuals must obtain a Letter of Medical Necessity (LMN). A licensed healthcare provider, such as a physician, chiropractor, or physical therapist, must issue this letter.

The LMN must contain specific details. It should clearly state:
The specific diagnosis or medical condition for which massage therapy is recommended.
The medical professional’s explicit recommendation for massage therapy as a necessary treatment.
The type of massage recommended, such as deep tissue or lymphatic drainage.
The recommended frequency and duration of the treatment, for instance, once a week for three months.

The LMN needs to explain how the massage therapy will directly alleviate the specified medical condition or affect a particular structure or function of the body. The document must be signed and dated by the recommending healthcare provider. While an LMN is not submitted with every claim, it is an essential record to retain in case of an audit by the HSA administrator or the IRS, providing clear evidence of medical necessity.

Common Non-Qualified Massage Expenses

Many scenarios involving massage therapy do not meet HSA eligibility criteria because they lack a direct medical purpose. Massage for general relaxation or stress relief, without a diagnosed medical condition, will not qualify. These are considered general wellness expenses and are not eligible for reimbursement.

Spa treatments, even with massage components, are generally not eligible HSA expenses. Their purpose is typically relaxation or cosmetic enhancement, not treating a specific disease or medical condition. Massage services purchased as gifts or for purely cosmetic purposes also fall outside the IRS definition of medical care.

Even if a massage addresses physical discomfort, it may not qualify if not part of a doctor’s prescribed treatment plan. The IRS maintains a strict interpretation of “medical care,” emphasizing the expense’s primary purpose must be the treatment or prevention of a specific medical condition. Expenses for general health improvement or pleasure do not meet these requirements for HSA reimbursement.