Does Medicare Pay for Massage Therapy?

Medicare is a federal health insurance program for individuals aged 65 or older, younger people with certain disabilities, and people with End-Stage Renal Disease. The program provides coverage for various healthcare services and supplies, operating under specific guidelines to determine what is covered. Understanding these guidelines, particularly concerning services like massage therapy, helps beneficiaries navigate their healthcare options.

Understanding Medicare’s Coverage Approach

Medicare’s coverage decisions are primarily based on the concept of “medical necessity.” This principle dictates that for a service, item, or treatment to be covered, it must be considered reasonable and necessary for diagnosing or treating an illness or injury, or to improve the functioning of a malformed body part. Services must also meet accepted standards of medical practice. If a service is not deemed medically necessary, Medicare generally will not cover it.

The Centers for Medicare & Medicaid Services (CMS) establishes national coverage determinations (NCDs) and local coverage determinations (LCDs) by regional Medicare contractors. Services considered routine, preventive, or solely for general wellness, relaxation, or convenience are typically not covered under Original Medicare.

For a service to be deemed reasonable and necessary, it must be safe and effective, not experimental or investigational, and appropriate for Medicare patients. This includes considerations for the duration and frequency of the service, ensuring it is provided in an appropriate setting by qualified personnel. Medicare aims to cover services that meet a patient’s medical needs without exceeding them.

When Massage-Related Therapies May Be Covered

Original Medicare generally does not cover massage therapy for relaxation, general wellness, stress relief, or as a standalone service. Services explicitly categorized as “massage therapy” by a chiropractor are not covered. However, certain manual therapy techniques that may resemble massage can be covered under specific circumstances.

Manual therapy techniques, such as mobilization, manipulation, or manual lymphatic drainage, can be covered if they are an integral part of a larger, medically necessary treatment plan. These techniques are typically covered when performed by licensed and Medicare-approved healthcare professionals, such as physical therapists (PTs), occupational therapists (OTs), or chiropractors, within their scope of practice. For instance, physical therapy and occupational therapy often incorporate manual therapy to restore function, reduce pain, and improve mobility for specific conditions or injuries.

Medicare Part B covers medically necessary outpatient physical therapy and occupational therapy services, including manual therapy, as long as they are prescribed by a doctor. For chiropractic care, Original Medicare Part B specifically covers manual manipulation of the spine to correct a vertebral subluxation, which refers to spinal bones that are out of position.

For billing purposes, manual therapy techniques are often reported using CPT code 97140, which specifies manual therapy for one or more regions, billed in 15-minute units. Documentation must clearly justify the medical necessity of the manual therapy, detailing the techniques used, treatment duration, and the patient’s response. While there are no annual limits on the number of medically necessary physical or occupational therapy sessions, if costs exceed a certain threshold, such as $2,410 for physical therapy in 2025, a doctor must confirm and document that further therapy is still necessary.

Exploring Medicare Advantage and Other Avenues

Beyond Original Medicare, Medicare Advantage Plans, also known as Part C, are offered by private companies approved by Medicare. These plans are required to cover all services provided by Original Medicare, but they often include additional benefits that Original Medicare does not cover. Some Medicare Advantage plans may offer supplemental benefits that could include coverage for alternative therapies, wellness programs, or even specific types of therapeutic massage. These non-medical benefits are designed to address a broader range of health and well-being needs.

To determine if a specific Medicare Advantage plan offers coverage for massage therapy or other alternative treatments, beneficiaries should review their plan’s documents. The Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) documents provide details on plan benefits, costs, and terms. These documents are crucial for understanding potential additional benefits.

If Medicare, including Medicare Advantage, does not cover a desired massage therapy service, other avenues for coverage might exist. Private health insurance plans, if applicable, may offer varying levels of coverage for alternative therapies. In cases where massage therapy is related to a workplace injury, workers’ compensation insurance could potentially provide coverage. Individuals may also choose to pay for massage therapy services out-of-pocket if they are not covered by any insurance plan.