Can You Use Your HSA to Pay for a Massage?

A Health Savings Account (HSA) offers a valuable way to save and pay for healthcare expenses with tax advantages. This specialized account allows individuals to contribute pre-tax dollars, which can then grow tax-free and be withdrawn tax-free for qualified medical expenses. Whether massage therapy qualifies for HSA reimbursement depends entirely on specific conditions and its purpose.

HSA Eligibility for Medical Expenses

The Internal Revenue Service (IRS) defines a qualified medical expense as an amount paid for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body. These expenses must primarily serve to alleviate a physical or mental defect or illness. Funds cannot be used for expenses that are merely beneficial to general health, such as vitamins or a vacation. An expense is qualified if it would generally be deductible as a medical expense on Schedule A (Form 1040) of an income tax return. This rule ensures HSA funds address genuine healthcare needs, not general wellness or cosmetic purposes.

Specific Requirements for Massage Therapy

Massage therapy is generally not considered a qualified medical expense if its purpose is for general relaxation or wellness. To be eligible for HSA reimbursement, massage therapy must be prescribed by a licensed healthcare professional, such as a physician, chiropractor, or physical therapist. This prescription must be for a specific, diagnosed medical condition. It cannot be a self-prescribed treatment, even if an individual experiences personal benefits.

The healthcare professional typically provides a “Letter of Medical Necessity” (LMN) to validate the medical need for the service. This document must clearly state the specific medical condition being treated and explain how massage therapy will alleviate or treat that condition. The LMN should also specify the recommended duration and frequency of the treatment. Common conditions for which massage therapy might be prescribed include chronic pain disorders, muscle injuries, or post-surgical rehabilitation. For ongoing treatment, a new LMN may be required annually.

Documentation and Reimbursement Process

To claim HSA reimbursement for eligible massage therapy, individuals must maintain specific documentation. This includes the Letter of Medical Necessity from the healthcare provider, which details the medical condition and prescribed treatment. Additionally, itemized receipts from the massage therapist are necessary. These receipts should clearly show the date of service, a description of the service provided, the cost, and the provider’s details.

When submitting claims to the HSA administrator, individuals typically use an online portal or a mail-in form, though specific procedures vary by provider. While HSA administrators may not always require submission of receipts for every transaction, it is imperative to retain all documentation for personal records. The IRS requires individuals to prove that HSA distributions were used for qualified medical expenses in the event of an audit.

Failure to provide adequate documentation to the IRS can result in the non-qualified expense being subject to income tax, along with a 20% penalty if the account holder is under 65 years old. Records, including the LMN and itemized receipts, should be kept for at least seven years after the relevant tax return is filed. This ensures proof that the expenses were qualified, not reimbursed from another source, and not claimed as an itemized deduction on a tax return.