Believe it or not, Medicare will help pay for massage therapy IF you meet certain qualifications. Here’s what you need to know.
Massage therapy is a type of treatment that manipulates soft tissues in your body. While typically used for relaxation, it can also be beneficial for some health conditions. For example, benefits of massage therapy may include increased flexibility, improved joint mobility, reduced muscle and joint pain, increased circulation, and fewer headaches/migraines.
It can also be beneficial for conditions like arthritis, cancer-related pain, fibromyalgia symptoms, muscle strain from injury, and more.
If you have pain, especially back pain, you may be searching for treatment options to help relieve pain and make day-to-day activities easier. Read on to learn more about what Medicare beneficiaries need to know about coverage for massage therapy for back pain, and other services that can help.
What is massage therapy?
Massage therapy, used to help manage a health condition or enhance wellness, involves manipulating the soft tissues in the body through rubbing and kneading. It’s typically used to try to relieve pain, especially in the lower back, neck, and shoulders, but can also be used to reduce stress and relieve muscle tension.
There are different techniques such as Swedish or classical massage, sports massage, clinical massage, and Shiatsu. In order for massage therapy to be classified as medical treatment, it must be provided by a licensed and certified massage professional.
Medicare coverage for massage therapy for back pain
Original Medicare Part A (hospital insurance) and Part B (medical insurance) will not cover massage therapy for Medicare beneficiaries. The Centers for Medicare & Medicaid Services (CMS) classifies massage therapy as an “alternative and complementary medicine,” so even if it’s used to treat medical issues, it will not be covered.
If you receive massage services, you will pay 100% of the cost out-of-pocket.
That said, therapeutic massage services provided by a physical therapist as part of a medical treatment plan may be covered by Part B (if considered medically necessary).
Do Medicare Advantage plans cover massage therapy?
Owned by private insurance companies, Medicare Advantage plans (MA, also known as Medicare Part C) must provide at least all of the same benefits as Original Medicare. However, one benefit to MA plans is that they also often offer additional benefits such as hearing, vision, dental, prescription drug coverage, fitness memberships, and more.
Benefits and coverage differ by plan, but many MA plans include benefits for massage therapy for pain. Typically, plans may either pay a flat amount for a massage therapy session or offer an annual massage therapy allowance. Some plans require an order from your doctor and proof of medical necessity, and others may only cover services received with certain massage therapy providers.
Check with your plan to learn more about its massage therapy benefits. And if you're looking for a Medicare plan that covers massage therapy, give our Find a Plan tool a try. Just enter your zip code to review the benefits and costs of Medicare plans in your area.
Does Medigap cover massage therapy?
Medicare supplement insurance, or Medigap, help fill in the “gaps” of Original Medicare and cover out-of-pocket costs like deductibles, copays, and coinsurance. If you get massage therapy from a licensed physical therapist and it is covered by Part B, your Medigap plan will help cover your out-of-pocket costs. The amount covered depends on which plan you choose. You can learn more about Medicare Supplement Insurance here.
If you get treatment for your back pain from a massage therapist, you are responsible for the costs on your own.
Cost of massage therapy
On average, a massage ranges from $50 to $150 per hour. The price may be influenced by the location, type of massage, and experience level of the therapist. It also depends on where you’re getting the massage. For example, a full-body massage may cost more than one focused on your back or neck.
Other options for pain covered by Medicare
Medicare won’t cover massage therapy, even for back pain, but Part B does cover other types of therapeutic treatments which can help your pain, including:
Physical therapy is care that evaluates and treats injuries and diseases that change your ability to function and improves or maintains current function or slows decline. Physical therapy and exercise can be one of the best ways to reduce pain in your back. Physical therapists not only help treat pain, but they also look for the cause of pain and discomfort and design exercises and stretches to diminish that pain. Not only can this help reduce the risk of further injury, but it could also reduce the risk of falling and even eliminate the need for surgery.
When your doctor or provider certifies you need it and it’s medically necessary, Medicare Part B helps pay for outpatient physical therapy. There’s no limit on how much Medicare pays for outpatient therapy services in one calendar year. After meeting the Part B deductible, you pay 20% of the Medicare-approved amount.
You can get physical therapy from a physical therapist at an office of a privately practicing therapist, medical office, outpatient hospital department, rehabilitation facility, skilled nursing facility (SNF), or at home.
Learn more about surprising conditions your physical therapist can treat.
Vertebral subluxation may cause muscle stiffness or inflexibility, as well as pain in the back or neck. This may make performing easy tasks difficult due to the inability to move properly.
Medicare Part B covers manual manipulation of the spine by a chiropractor to correct vertebral subluxation, which is when the spinal joints fail to move properly but the contact between the joints remains intact.
It does not cover other chiropractic services or tests a chiropractor orders, such as X-rays, massage therapy, and acupuncture (unless for treatment of chronic low back pain).
You pay 20% of the Medicare-approved amount for these services (after paying the Part B deductible).
Acupuncture is a technique where providers stimulate specific points on the body, typically by inserting thin needles through the skin. Medicare Part B covers up to 12 acupuncture visits in 90 days for chronic lower back pain.
An additional eight sessions may be covered if you show improvement. However, if you aren’t showing improvement, Medicare won’t cover additional treatments. You can get a maximum of 20 acupuncture treatments in a 12-month period. You will pay 20% of the Medicare-approved amount after meeting the Part B deductible.
Note that chronic low back pain is defined as lasting 12 weeks or longer, not having an identifiable cause, and pain that isn’t associated with surgery or pregnancy.
To be covered, you must get acupuncture from a doctor or provider who has a masters or doctoral level degree in acupuncture or Oriental Medicine from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine, and a current, full, active, and unrestricted license to practice acupuncture in the state where you’re getting care.