Session Lengths Vary
- Out of pocket costs may vary from plan to plan.
- CPT code 97124 or 97140
Having health insurance that covers massage can definitely make care more affordable and accessible. Here are some good things to know about working with your health insurance plan.
Treatment massage and insurance coverage
While we believe deeply in the value of massage therapy as part of an overall preventative and wellness plan, as we understand it, health insurance coverage for massage therapy is generally limited to addressing acute musculoskeletal issues (joint pain, muscle pain, back pain, neck pain, headaches, muscle strain/sprain, muscle spasms, etc) that are expected to improve with consistent care over a set period of time. With this in mind, we will be setting goals with you and documenting your progress; we will also ask you to commit to a consistent treatment plan. If scheduling proves to be too challenging, we may refer you on to another clinic to ensure that you receive the care you need in a timely fashion. Preventative care and care for relaxation/stress reduction is almost never covered, even if your doctor recommends the care for these reasons.
Am I covered?
Please note that coverage varies widely from plan to plan so we ask that you call your insurance company or talk to your company’s HR department in advance to verify coverage and learn the details. We recommend that you do so every year, as plan details are subject to change. You are ultimately responsible for the cost of your care, regardless of what happens with your insurance claim.
Good questions to ask your insurance company or HR department:
- Is massage therapy covered with a licensed massage therapist? (Sometimes, it is only covered with a PT, DC or MD.) Is my massage therapist considered in-network with this plan? If not, do I have out of network coverage?
- Do I have a deductible (an amount of money that you pay out each year before your coverage kicks in)? If so, has it been met yet? Does it apply to massage therapy coverage? What is the allowed amount (this is the amount we agree to accept per the contract with your insurance company) per visit for CPT code 97124 or 97140 (four units = a 60 minute session)? This allowed amount is not the same rate we charge and accept for payment at the time.
- Is there a visit limit or monetary limit? And, do other forms of care count towards the visit limit? (Often, massage is part of a rehab benefit, which includes PT and other forms of care, or an alternative care benefit, with acupuncture and nutrition.)
- Do I have a copayment? Or coinsurance? How much is it?
A prescription is required for any care covered by health insurance, even if your plan doesn’t explicitly require it, because nearly all coverage for massage is based on the documented medical necessity of the care. As massage therapists, we cannot diagnose conditions, and therefore, cannot confirm officially that your care is medically necessary in the eyes of an insurance plan.
A prescription from your doctor should include:
- A start and end date (If your doctor recommended four visits once a week, the script expires four weeks from the start date.)
- An ICD-10 diagnosis code for a musculoskeletal system problem or related issue
- The number of visits recommended
NOTE: We will focus on the areas noted on the prescription.
Your doctor may email us your prescription to email@example.com or mail it to 227 NE Hillcrest Drive, Grants Pass, Oregon 97526.
To schedule an initial insurance session, please contact our office.
Motor Vehicle Accidents (MVA)
Massage therapy can be a great resource for treating common injuries sustained in an automobile accident, such as whiplash, headaches, neck pain, fatigue, sleeplessness and back pain. If you’ve been injured, we’d love to help. To get the ball rolling…
See your doctor
First, see your doctor or chiropractor for an exam and assessment and to discuss your treatment options. If your doctor feels massage therapy could be helpful, ask for a prescription for massage. (Your doctor may email it to us at firstname.lastname@example.org)
Send us your claim information
Please send us the following as soon as possible via email or phone:
- Name of the auto insurance company
- Your claim number
- Date of the accident
- Name and phone number of the person managing your claim (sometimes called a claim adjustor)
Ideally, the insurance information you provide to us will be for a claim that you have opened with YOUR auto insurance company, regardless of who is at fault. This potentially enables your medical providers to be paid for your care as the costs accrue via the Personal Injury Protection (PIP) policy that is probably available on your insurance policy. (As we understand it, opening a claim with your insurer should not impact your premiums if you are not at fault.) Without PIP coverage, you may be able to use your health insurance or we can discuss other payment options.