Getting approved to accept insurance for massage therapy services depends on state laws and differences among various insurance plans. Each state has unique massage therapist licensing requirements and each insurance company has unique reimbursement policies.
You generally must be a licensed massage therapist in most states to even offer massage therapy services, much less to bill insurance companies for services provided. In Georgia, for example, you must submit to a background check, successfully complete a minimum of 500 hours of course and clinical work and pass the National Certification Examination for Therapeutic Massage and Bodywork, or an equivalent test by another state that has license requirements that meet or exceed those of Georgia.
Auto and Workers' Comp Insurance
According to the Institute for Integrative Health Care, all 50 states allow you to bill insurance companies for massage therapy services related to on-the-job injuries—workers' compensation—and injuries associated with automobile accidents. Your clients will need doctor referrals. Some states, like Washington, allow “insurance credentialing.” This allows massage therapists to contract directly with insurance companies within the health care system as part of that provider's network. To get credentialed, you must go through an evaluation process in which insurers assess your qualifications based on a background check, the quality of your license, your education, and training history.
The Affordable Care Act
Section 2706 of ACA mandates the inclusion and reimbursement of licensed health care providers in health insurance plans. However, Section 2706 does not specifically list massage therapists as licensed health care providers. Neither does ACA require the inclusion of every licensed health care provider in health plan networks. Networks must include a sufficient number to serve the population, except in the few states having “every willing provider” clauses. Moreover, insurers have the discretion to determine the provider procedures covered and the prices they will pay for those procedures.
ACA Meets Real World
Since ACA went into effect, some massage therapist professional associations report that ACA is not necessarily helpful and is barring market access in some cases. One concern is that massage therapy is not included among the 10 listed mandatory “essential benefits” insurers must cover to be in compliance with ACA. The Integrative Health Care Policy Consortium reported that many plans in Oregon delisted previously covered massage procedures ostensibly to be in compliance with the “essential benefits” mandate. Massage Practice Builder attributes one major problem to each state having different licensing for massage therapists. Some state licenses do not carry the designation of “Health Care Provider.” Moreover, many states were not in total compliance with ACA as of early August 2014.
Get Licensed and Credentialed
Insurance acceptance is not a slam-dunk under ACA. Stay current on licensing requirements for your state, massage therapist credentialing requirements for the authorized ACA provider networks in your area and the Current Procedural Terminology codes for massage therapy. Moreover, massage therapy is complementary and alternative medicine according to the National Center for Complementary and Alternative Medicine. Follow the general CAM insurance reimbursement guidelines, which state that such therapies can be reimbursable under Department of Health and Human Services CFR 410.43 provisions when prescribed by a licensed “medical” practitioner, are reasonable and necessary, are goal-directed based on a documented treatment plan, and when the patient shows improvement.
- Ga.gov: Georgia Massage Therapy Practice Act, Title 43. Professions and Businesses, Chapter 24A
- Institute for Integrative Health Care: Insurance Billing for Massage Therapists
- GroupOne Health Care: Medical Credentialing
- Massage Practice Builder: Massage and the ACA (2014)
- Associated Bodywork & Massage Professionals: An Update on the Affordable Care Act
- HealthCare.gov: Essential Health Benefits
- Massage Today: CPT Codes
George Boykin started writing in 2009 after retiring from a career in marketing management spanning 35 years, including several years as CMO for two consumer products national advertisers and as VP for an AAAA consumer products advertising agency. Boykin mainly writes about advertising and marketing for SMBs.