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Getting massage therapy covered by health insurance in the US.

All over the US, various organizations are calling for the inclusion of massage therapy in healthcare to help combat the Opioid epidemic and more.
Massage Therapy can help with pain relief and management, and can be a big part of resolving many musculoskeletal injuries and conditions. Many organizations are calling for alternative options for pain such as massage therapy among other therapies.
Meanwhile in WA State, massage therapists have been able to bill health insurance for the many pain related injuries and conditions because of a law that was created in 1993 called the Every Category Law (WAC 284-170-270) that states:

   “(1) Issuers must not exclude any category of providers licensed by the state of Washington who provide health care services or care within the scope of their practice for services covered as essential health benefits, as defined in WAC 284-43-5640 and 284-43-5642 and RCW 48.43.715, for individual and small group plans; and as covered by the basic health plan, as defined in RCW 48.43.005(4), for plans other than individual and small group.

For individual and small group plans, the issuer must not exclude a category of provider who is licensed to provide services for a covered condition, and is acting within the scope of practice, unless such services would not meet the issuer’s standards pursuant to RCW 48.43.045 (1)(a). For example, if the issuer covers outpatient treatment of lower back pain as part of the essential health benefits, any category of provider that provides cost-effective and clinically efficacious outpatient treatment for lower back pain within its scope of practice and otherwise abides by standards pursuant to RCW 48.43.045 (1)(a) must not be excluded from the network.”

The Every Category Law was fought by the insurance companies for about 5 years and guess what…. the Every Category Law won and won big.  A Supreme Court decision ended the battle with the Every category law moving forward.See the time line of events in implementing the Every Category Law in WA State – Report of the Clinician Workgroup on the Integration of Complementary and Alternative Medicine January 2000. Washington State.

The insurance companies in WA State also require that there be a loss of function AND pain in order for massage therapy to be covered by health insurance.  That means massage therapy is used to help with many conditions such as carpal tunnel, herniated discs, headaches and much more than just pain issues.

The Call for Massage Therapy

In 2010, The Affordable Care Act opened the doors with Section 2706 that said insurance companies “shall not discriminate”against any health provider with a state-recognized license. Section 5101 includes licensed complementary and alternative medicine providers and integrative health practitioners in its definition of health professionals in the“health care workforce.” Yet nothing was done by any of the massage therapy associations.
In 2011, Relieving Pan in America:(PDF) A Blueprint for Transforming Prevention, Care, Education, and Research said reviews of research on acupuncture, massage, and chiropractic spinal manipulation for chronic low back pain suggest these therapies may be beneficial.
In 2016, the CDC even said: “Although there are perceptions that opioid therapy for chronic pain is less expensive than more time-intensive nonpharmacologic management approaches, many pain treatments, including acetaminophen, NSAIDs, tricyclic antidepressants, and massage therapy, are associated with lower mean and median annual costs compared with opioid therapy. CDC Guideline for Prescribing Opioids for Chronic Pain “— United States, 2016
In Feb 2017, the National Association of Attorney Generals, issued this letter (PDF), asking for alternatives to Opioids be considered to help end the epidemic.“When patients seek treatment for any of the myriad conditions that cause chronic pain, doctors should be encouraged to explore and prescribe effective non-opioid alternatives, ranging from non-opioid medications (such as NSAIDs) to physical therapy, acupuncture, massage, and chiropractic care. “
In Jan 2018, the Academy of Integrative Pain Management (AIPM) and the US Pain Foundation, wrote a letter to the U.S. Senate Committee on Finance (the Committee with jurisdiction over the Centers for Medicare and Medicaid Services, or CMS), asking them to cover massage therapy.

The Joint Commission has also previously called for coverage of massage therapy in 2015 (PDF) “Revised Rationale for PC.01.02.07 (New for Ambulatory Care and Office-Based Surgery Practice)

“The identification and management of pain is an important component of [patient]-centered care. [Patients] can expect that their health care providers will involve them in their assessment and management of pain. Both pharmacologic and nonpharmacologic strategies have a role in the management of pain. The following examples are not exhaustive, but strategies may include the following: Nonpharmacologic strategies: physical modalities (for example, acupuncture therapy, chiropractic therapy, osteopathic manipulative treatment, massage therapy, and physical therapy), relaxation therapy, and cognitive behavioral therapy”and again in 2017   ”

“When a patient’s preference for a safe nonpharmacologic therapy cannot be provided, hospitals should educate the patient on where the treatment may be accessed post-discharge. Nonpharmacologic strategies include, but are not limited to: physical modalities (for example, acupuncture therapy, chiropractic therapy, osteopathic manipulative treatment,massage therapy, and physical therapy), relaxation therapy, and cognitive behavioral therapy.”

In April 2017, the American College of Physicians did a study to systematically review the current evidence on nonpharmacologic therapies for acute or chronic nonradicular or radicular low back pain and here is their recommendation: “Recommendation 1: Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate- quality evidence),massage, acupuncture, or spinal manipulation (low-quality evidence).” https://www.ncbi.nlm.nih.gov/pubmed/28192793

In April 2017, Federation of State Medical Boards April 2017 adopted their policy on Chronic use of Opioids and recommended: “The treatment plan may contain information supporting the selection of therapies, both pharmacologic (medications other than opioids to include anti-inflammatories, acetaminophen, and selected antidepressants and anticonvulsants) interventional, and non-pharmacologic therapies such as cognitive behavioral therapy,massage, exercise, multimodal pain treatment, and osteopathic manipulative treatment. The plan should document any further diagnostic evaluations, consultations or referrals, or additional therapies that have been considered to the extent they are available.
In Oct 2017, the first Integrative Pain Policy Conference was held in San Diego. The AMTA was invited and was supposedly there according to the report from the Academy of Integrative Pain Management, but to date I have not heard any report from the AMTA. The Congressional Integrative Health and Wellness Caucus held on March 15, 2015 calls for:

The mission: “Amidst Opioid Crisis: New Caucus Will Focus on Integrative Health Solutions.

Make sure you contact your legislative representative and ask them to JOIN. Medicare Managed Care Manual Chapter 4 – Benefits and Beneficiary Protections. Revised for 2019 coverage Year also calls for more massage therapy as an alternative to Opioids.
“Medically-Approved Non-Opioid Pain Management (PBP B13d, e, or f ): Medically-approved non-opioid pain treatment alternatives, including therapeutic massage furnished by a state licensed massage therapist . “Massage” should not be singled out as a particular aspect of other coverage (e.g., chiropractic care or occupational therapy) and must be ordered by a physician or medical professional in order to be considered primarily health related and not primarily for the comfort or relaxation of the enrollee. The non-opioid pain management item or service must treat or ameliorate the impact of an injury or illness (e.g., pain, stiffness, loss of range of motion).” https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/mc86c04.pdf
Massage Therapists are licensed as Health Care Providers in over 20 states. This is the list that I have so far, collected from various Facebook Groups so check the sources and let me know of any corrections.AL, CO, CT, FL, GA, LA, MI, MD (LMTs only) MO, NC, NM, NY, OH, OR, TN, VI, WA, Wa DC, WI, WV, WY.In most states, massage therapists can bill for car accident related injuries and for work related injuries.With so much interest and backing from prominent organizations calling for massage therapy to become part of the answer to the Opioid Epidemic, where is the Massage Therapy Profession?

How to get massage therapy covered by health insurance in your state.

  • Find out if you are licensed as a health care professional. Please find the link to a page in your laws that show that massage is licensed as a health care profession in your state and share in the comments.
  • Look at what has been done in WA State in this arena. They have been able to bill health insurance since about 1996 because of a law called the Every Category Law http://apps.leg.wa.gov/wac/default.aspx?cite=284-170-270 that was put into place after a long battle with the insurance companies that wanted to stop it. There is even a supreme court decision making it into law. See time line of events in implementing the Every Category Law in WA State – Report of the Clinician Workgroup on the Integration of Complementary and Alternative Medicine January 2000. Washington State
  • Join Healthcare Integration for Massage Therapists   Facebook group
  • Find out what is happening in your state on creating a different law that would make health insurance companies cover massage.
  • Find out what your AMTA chapter is doing. Here is a list of them on Facebook. https://www.facebook.com/lists/10151631915757567 Here is a list of them on the AMTA website: http://www.amtamassage.org/chapters/index.html Many of the AMTA Chapters are not currently doing anything but a few are. OH, WI, WV are working on getting laws passed that include coverage for massage therapy.
  • If your AMTA Chapter is not working on anything and they are not interested in working on anything – Join them and tell them you want to be on the Government Relations Committee. You will need them to get a lobbyist to help you. A lobbyist costs about $40,00-$100,000 a year. AMTA should be paying for the lobbyist in your state.
  • If you can’t get anywhere with AMTA, start your own separate state organization – like WA did – WA State Massage Therapy Association. . No one has been at the table for us and in the past 6 years or so – the insurance companies have been constantly reducing our allowable fees making it more difficult to make a living billing health insurance. This will be a much slower process as you will need to have enough members and make enough to pay a lobbyist. Keep working on AMTA Chapters until they let you do this or want to be involved.
  • Find out what your Insurance commissioner needs and start the conversation with them about getting massage integrated into healthcare. http://www.naic.org/state_web_map.htm
  • Write a letter to be sent to the OIC in your state. You will need this info for the OIC and use the above requests for massage therapy to be incorporated into healthcare along with these papers: MASSAGE THERAPY IN INTEGRATIVE CARE & PAIN MANAGEMENT (PDF) Published by the American Massage Therapy Association The Value and Efficacy of Massage therapy. Published by the American Massage Therapy Association Summary of Evidence (PDF) – How massage fits into the Essential Health Benefits  (Created by AMTA-WA).
  • Write a letter that clients can send to their insurance company asking for massage therapy to be covered.
  • Write a letter that clients can use to send to the OIC.
  • See also: www.covermycare.org http://www.covermycare.org/cmc/the-cmc-toolkit/
  • You will also need a Political Action Committee. WA State has one that was started in about 2005 to help support candidates who support massage therapy – WA Massage Alliance for Health (www.wamah.org) Our Every Category Law constantly needs protection and to get anywhere with healthcare, you need a PAC. Oh and why don’t we have a National PAC???
So there you have enough to get yourself started. These are just my suggestions after seeing what has happened in WA State and being on the Board of a few organizations.
Join my closed Facebook Group : Health Care Integration for Massage Therapists to
continue the discussions and start creating plans.

Overcoming the Objections to getting massage covered by health insurance.

My goal here is to get massage therapists to the table with the powers that be – insurance commissioners, health insurance carriers and legislators before they just jump in and make massage therapy covered by health insurance.  From what I have been seeing, so many things are pointing us in that direction (see above), but we are not ready.  We need to be part of the process of setting this up so we can have more of a say in what is set up.

The health care system is broken.  Yes it is, but it is what it is.  What will it be like if/when it moves to a one-payer system?

It takes too much time to bill and get paid.  Billing health insurance is all done electronically and once you are credentialed with a carrier, the payment times are about two to four weeks.

You have to do too much paperwork.  Paperwork is really minimal and not much more then you need to be doing already.  SOAP charting and filling out the CMS 1500 billing form are all done online.

You won’t be able to work in the way you want and your massage will be dictated by the insurance.  Not really.  You won’t be able to do full body relaxation massage.  It will be specific area massage therapy for rehabilitation of conditions like carpal tunnel syndrome, herniated discs, headaches and more.  If you can support your massage work through charting, you can do it.

It is coming folks…whether we/you want it or not.  The clients/patients want massage therapy covered by health insurance.

Why not be on the forefront of making it happen and have our voices heard from the start?

Learn to bill health insurance and be involved in
getting massage therapy covered by health insurance.