This has been a very common question I've been getting in my practice. I've been asked this question so much, that I feel I need to address it here. This particular entry mainly answers the question regarding private insurance companies.
The short answer to this question is "no". The reason isn't because I don't want to. In my research, I discovered that if you practice massage therapy in the State of Arizona, private insurance companies won't credential you. Credentialing gives you the ability as a massage therapist to bill the insurance companies directly. Until the laws change, I currently am unable to do so.
There are other avenues to explore if you want your massage covered by your insurance company. Your Health Care Provider (HCP) can prescribe or refer you to me. In order for your HCP to refer or prescribe, it must be deemed medically necessary. There are specific diagnostic codes That insurance companies will look for to determine medical necessity. Some common ones are:
There are many, many other diagnostic codes.. If you are feeling particularly curious or having trouble falling asleep, you can find them here:
I currently do electronic charting and will work with any HCP to track progress and help improve your condition. Some doctors' offices may be able to bill the insurance companies on my behalf to minimize your out-of-pocket cost.
If your HCP is unable to bill the insurance companies for my services, (more than likely this will be the case) I can furnish what is known as a "super bill". This is a detailed receipt that you would submit to your insurance company for reimbursement. The super bill will contain the appropriate Current Procedural Terminology (CPT) codes and the ICD-9 (International Classification of Diseases) diagnostic codes. Your physician will have to provide the ICD-9 codes in the prescription or referral. I have referral / prescription forms in my practice for your HCP to fill out.
Additionally, if you would like to have insurance cover your massage sessions, there is also a bit of leg work needed to see if you will be either reimbursed from your private insurance company or covered.
Here's an excerpt from a billing information form I located from my ABMP membership website that may help you determine whether or not you will be covered or reimbursed:
Private Health (Additional information is necessary if billing your health insurance) Does the insurance plan cover massage therapy? Yes ☐ No ☐ Does it cover massage therapy provided by a massage therapist (LMT, LMP, RMT, CMT, etc)? Yes ☐ No ☐
Does it cover massage therapy for this condition (____________________)? Yes ☐ No ☐
Does the treatment have to be referred? Yes ☐ No ☐
Prescribed? Yes ☐ No ☐
Does the treatment have to be pre-authorized? Yes ☐ No ☐
What is the annual massage therapy benefit (# of visits or $ amount)? ______________
How much is remaining for this year? _______________________
Do the benefit limits include PT, DC as well? Yes ☐ No ☐
How much is remaining for this year? ________________
What is the deductible? _____________
How much as been satisfied to date? _____________
Is there a co-pay? Yes ☐ No ☐ How much? _______________________ Does the massage/bodywork practitioner have to be a preferred/credentialed provider in the network? Yes ☐ No ☐
Is _________________________ a preferred/credentialed provider?
Yes ☐ No ☐
Are there out-of-network benefits available? Yes ☐ No ☐ If yes, what % is covered/what is the co-insurance payment? ______________
What is the deductible for out-of-network care? _______________________ How much has been satisfied to date? __________________
If you are receiving physical therapy or chiropractic care and you want to have your massage service covered as well, you cannot receive massage the same day as chiropractic or physical therapy. This is because it will look as though you are double-billing. The practitioner who submits the claim first usually will be the only one reimbursed.
I hope you find this somewhat helpful. If you are interested in having your massages covered by your insurance and have questions, feel free to contact me at firstname.lastname@example.org.
Another affordable option for massage / bodywork services is our monthly wellness plan. It's easy to enroll (no contract only 30 days notice to cancel). You can find out more information regarding our wellness membership here.