Does Medicare Cover Massage Therapy for Fibromyalgia?

Medicare coverage for services like massage, especially for chronic conditions such as fibromyalgia, can be complex. This article clarifies whether, and under what conditions, Medicare may cover massage therapy for fibromyalgia.

Understanding Medicare Coverage for Massage Therapy

Original Medicare (Parts A and B) generally does not cover massage therapy as a standalone service. Medicare categorizes massage therapy as “alternative and complementary medicine,” typically not deeming it medically necessary for direct payment. Beneficiaries are usually responsible for 100% of the costs if billed independently.

However, there is an important distinction: Medicare Part B may cover therapeutic services that incorporate massage techniques if they are an integral part of a broader, medically necessary treatment plan. This means that while a “massage” may not be covered, specific manual therapy techniques performed by a licensed professional as part of physical therapy (PT) or occupational therapy (OT) for a diagnosed condition can be. Manual therapy, which includes techniques like joint mobilization, myofascial release, and trigger point therapy, is often covered under Part B when prescribed as part of a rehabilitation plan. These services must be reasonable and effective treatments for a patient’s condition and require the skills of a qualified therapist.

Fibromyalgia and Medicare Coverage Considerations

There is no specific Medicare benefit category for “massage therapy for fibromyalgia.” For any service incorporating massage-like techniques to be covered for fibromyalgia, it must meet medical necessity criteria and be part of a covered treatment plan, such as physical or occupational therapy, prescribed by a physician. The service must address a functional deficit or impairment directly resulting from fibromyalgia, not just provide general comfort or relaxation.

Services that include therapeutic massage techniques might be covered if billed under specific Current Procedural Terminology (CPT) codes for manual therapy, such as CPT code 97140. This code covers manual therapy techniques applied to one or more regions for medical purposes. The therapy must aim to restore or improve function and be provided by a licensed physical therapist or occupational therapist, not solely a massage therapist. Some Medicare Advantage Plans (Part C) may offer supplemental benefits that could include therapeutic massage coverage. Even with these plans, medical necessity is still a prerequisite, and there may be specific network or referral requirements.

Steps for Exploring Potential Coverage

Beneficiaries seeking coverage for therapeutic massage techniques for fibromyalgia should consult their physician. A doctor’s assessment and prescription for medically necessary therapy, outlining functional goals, are fundamental for potential coverage. The physician can determine if therapeutic services, such as physical or occupational therapy, are appropriate for managing fibromyalgia-related symptoms and can include manual therapy components.

Verify the provider’s credentials. Any covered service must be furnished by a licensed and Medicare-approved therapist, such as a physical therapist or occupational therapist, not a massage therapist billing solely for massage. Beneficiaries should inquire about the CPT codes the provider intends to use, as coverage depends on the code reflecting a medically necessary, covered therapy like manual therapy (e.g., 97140).

For those with Original Medicare, contact 1-800-MEDICARE to understand coverage for therapeutic services. If enrolled in a Medicare Advantage plan, contact your plan administrator to inquire about coverage for therapeutic services, including any supplemental benefits. If a provider believes a service may not be covered, they should issue an Advance Beneficiary Notice of Noncoverage (ABN), which informs the beneficiary of potential out-of-pocket costs before receiving the service.