Insurance Coverage and Prescriptions for Massage

The following information is meant as an informal overview of massage therapy health insurance coverage in Hawaii. 
I have written this with good intentions, but I do not make any claims to the accuracy of this information. 
Please consult your health insurance company, lawyer, or accountant to verify massage coverage and
 eligibility for tax credit or compensation.
*Massage therapy is covered under your health insurance policy when you have a CAM rider.*

Insurance covers hand massage in Hawaii

When do I need a referral or prescription for massage therapy?

There are some instances when you need a formal prescription for massage therapy from your medical doctor or primary care physician. A referral is a medical document that will be kept on file for insurance reimbursement purposes. It often resembles a prescription for physical therapy, stating your diagnosis and the prescribed treatment of massage therapy (97124). It includes all of your prescribing doctor's information. Some health insurance plans, such as Kaiser Permanente, require that you have a referral on file which has been written within the past year. If you have a workers compensation claim, motor vehicle accident or no-fault (PIP) insurance claim, or if you plan to seek other reimbursement, you will need to have a prescription for massage. You may also need proof of medical necessity for massage therapy if you plan to deduct your expenses on your income taxes or use money from a health care spending account (HSA). *Please consult a professional accountant, insurance company, or lawyer to verify if your expenses are eligible for compensation.  Just because you have a referral or prescription does not mean your massages are automatically deemed eligible. 

*HMSA usually allows patients to self-refer if they have complementary care coverage. This means that no referral may be necessary for massage in some cases.

Who can write my prescription for massage therapy?

If in doubt, always get your prescription from your primary care physician (PCP). Most companies will only accept them from licensed medical doctors. Some companies will also accept referrals from Chiropractors. 

Always get your prescription for massage therapy from a licensed medical doctor (M.D.) or (D.O.). 

the only exception in Hawaii is:
Kaiser Permenente accepts referrals from Chiropractors (D.C.).

What is the difference between a prescription and referral?

A prescription designates frequency and duration of treatment in addition to your diagnosis. For example, massage therapy twice a week for one month (2x wk/ 1 mo) to treat lumbago. A referral simply states a diagnosis and the treatment recommendation of massage without designating frequency and duration. 

Your documentation will need to contain the correct icd-10 and CPT codes.

If in doubt, always get a prescription. The only exception when a referral will suffice is when you are covered through Kaiser Permenente and certain other plans that are managed by American Specialty Health Group (ASH Group). HMSA does not normally require a prescription or referral.

How do I get a massage therapy prescription or referral?

If you have been involved in an accident, it is necessary to see a medical doctor to have your injury evaluated and documented. At your appointment, you can get a prescription from your doctor if massage therapy is recommended. They may also be willing to fax it directly to your massage provider. 

If you are currently seeing a doctor and have had a recent appointment, you might be able to obtain a referral over the phone. Your medical clinic can send it to you and/or your massage provider electronically, by mail, or by fax. Keep in mind, you will have needed sign a medical release form ahead of time that allows them to do this.

My doctor refuses to acknowledge that I have medical coverage for massage. What can I do?

Coverage for massage is easy to verify using the on-line database. If your doctor does not believe you are covered for massage and you are having a hard time getting a referral, tell them you verified coverage on-line. If you continue to have problems, you can call your insurance company and have them call your doctor's office to verify your coverage with them. 

It can be frustrating to get all the paperwork in order to start a treatment plan that includes massage therapy. Because of this, do not wait until the last minute. It may take a week or two before you can start getting massages. If you have any questions, I am happy to help. This process may seem complicated, but it is fairly simple once you get started and know what to do.

A word of caution regarding over-prescription of massage:

Massage therapy is part of a goal-oriented treatment plan. This means that your therapist will be measuring your progress with the intention of discontinuing therapy when you reach your goals or reach maximum therapeutic benefit. Even if massage therapy continues to enhance your quality of life, even if you still have some degree of pain- your massage therapy coverage claims must be reasonably discontinued. It is important not to abuse the system.

If you have chronic pain, do not expect your insurance claim to cover massage that does not produce a minimum clinical difference in assessment scores. You must be demonstrating progress with your pain level and/or disability. When the massage only helps your chronic pain for the short term, it necessitates your health care providers to turn to different treatment options other than massage.

Massage is not eligible for coverage as a preventative treatment. Hopefully, this may change in the future.

Mahalo for taking the time to learn more about massage therapy insurance coverage. I am by no means an expert in this matter, but I have done my best to share my knowledge with you. Please understand that this information may not be accurate. You must consult a specialist to verify the information on this page before using it to make any decisions.

Give my Waialua massage therapy clinic a call. We offer massage on the North Shore of Oahu, HI. Our massage therapy clinic is located just outside of Haleiwa town and convenient to Mililani and Wahiawa. We specialize in deep tissue massage for pain relief and prevention. If your health insurance policy has a complimentary health-care rider that covers massage therapy, we can accept your medical insurance for massage. I am a ASH Group massage therapy provider and can accept some HMSA, Kaiser, and other health insurance plans. 

I look forward to meeting you and helping you live life more fully,
Sonia Beauchamp 
"The Haleiwa Massage Muse"
Integrated Massage and Deep Tissue Therapy
in Waialua near Haleiwa at Ka'ala Healing Arts.
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