Health Insurance Coverage
WA State is one of only 2 states that allow massage therapists to bill health insurance for massage therapy sessions. We are lucky to live in a state that mandated (In 1983!) that massage therapy be covered.
- All massage sessions must be medically necessary meaning that they must follow the definitions set up by each carrier. Massage therapy is used for many conditions such as headaches, carpal tunnel syndrome, back/neck pain with loss of function, herniated discs, Pain syndromes with loss of function. Health insurance companies do NOT cover maintenance massage therapy. See more on the medical necessity definitions of some carriers. Find yours in your benefits booklet.
- A prescription from your doctor is required for all sessions that includes a diagnosis code (ICD 10 code that says what the problem is) and a treatment plan (how many sessions over what time period). Some insurance companies will say that a prescription/referral is not needed. That is not true. A massage therapist is not able to diagnose conditions according to the scope of practice laws. An ICD-10 (diagnosis code) is needed in order to even submit the bill to the insurance company. Since a massage therapist cannot diagnose, this must come from the doctor in the form of a prescription.
- Prior Authorization may be required. Some insurance companies such as Regence Blue Shield and Premera Blue Cross may require an additions step of obtaining a prior authorization. They have hired a third party company -eviCore – to complete this process. This is in addition to having a prescription. It does not matter how many sessions you have in your benefits for your plan. eviCore will dictate the number of sessions allowed. As of June 7 2018, the first 6 sessions on a new injury/condition that has not been treated before with massage therapy, will be allowed without prior authorization. (See Senate Bill 6157 )
Work Related Injuries – Labor and Industries.
If you are injured at work, you will need to contact your employer and start a claim with WA State Labor and Industries.
Massage therapy is covered for approximately 12 sessions, when prescribed by a physician, and deemed medically necessary.
Motor Vehicle Collisions (MVC)
If you are involved in car/vehicle collision, your car’s Personal Injury Protection Plan will cover your medical bills up front to the limits determined in your benefits.
Massage therapy may be covered when prescribed by a physician.