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    OpenPayerPolicy UpdatesPhysical Medicine, Rehab & TherapiesKaiser Permanente massage therapy Coverage | OpenP…
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    CurrentKaiser PermanentePolicy N/A

    Massage therapy coverage

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    Rules for when massage therapy is considered medically necessary or not for Kaiser Foundation Health Plan of Washington members, including Medicare-specific guidance and applicable CPT codes. Affects clinicians ordering or providing massage services and utilization reviewers.

    Policy Summary
    PayerKaiser Permanente
    PolicyMassage therapy coverage
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective DateN/A
    Last ReviewNov 5, 2024
    Next Review DateN/A
    Key ActionObtain a treating physician order and document assessment, diagnosis, objective limitations, expected improvement, and therapeutic benefit when requesting massage therapy.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    2Listed billable CPT codes for massage/manual therapy
    500 hrs

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Minimum training for WA massage therapists
    PT-onlyMedicare distinction
    Criteria A or BNon-Medicare coverage logic

    Medical Necessity and Coverage Rules

    Non-Medicare Medical Necessity

    Non-Medicare members: massage therapy is covered when either ALL items in A are met OR B applies

    Overall coverage options

    • A. Indication for non-Medicare members: 1. An assessment and diagnosis documents objective physical and functional limitations. 2. It will have physical therapeutic benefits. 3. It has been ordered by the treating physician. 4. The condition or the level of function can be expected to improve significantly within a reasonable and generally predictable period of time with massage treatment.

      All four must be met

    • B. Palliative/terminal care: The patient is terminally ill, and the therapy is needed for comfort.

      Any patient meeting B is eligible regardless of A

    A. Indication for non-Medicare members (expanded): 1. An assessment and diagnosis documents objective physical and functional limitations.
    2. It will have physical therapeutic benefits.
    3. It has been ordered by the treating physician.
    4. The condition or the level of function can be expected to improve significantly within a reasonable and generally predictable period of time with massage treatment.

    Medicare Members

    Medicare-specific coverage rule

    Medicare coverage: Massage is covered when delivered by a physical therapist as part of the rehabilitation plan of care.

    Not covered when delivered by a massage therapist who is not licensed as a physical therapist.

    Massage therapy is not covered when any of the following apply: it is provided for prevention, recreation (spa therapy), or stress reduction; it is directed at the maintenance of current level of functioning; or the patient has achieved therapeutic goals or is not showing meaningful progress. These uses do not meet the plan's definition of medical necessity and are considered exclusions for coverage.

    Additional exclusion language clarifies that massage delivered for general wellness, recreational or spa purposes, or solely to reduce stress is not a covered benefit. Coverage is likewise excluded when the intent is to preserve an existing functional status without expectation of significant improvement, or when therapeutic objectives have already been met or no meaningful progress is documented.

    Billable Codes and Coding Guidance

    Covered CPT CodesCPTCovered
    97124Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion).
    97140Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes.

    Referral, Documentation, and Billing Requirements

    Billing Rule

    Referral and coding

    Coverage applies when massage is a benefit in the member's contract and the consumer receives a health plan referral. Bill using CPT 97124 for therapeutic massage (15-minute units) and CPT 97140 for manual therapy techniques (15-minute units).

    • Covered when listed as a benefit in the member's contract and health plan referral is obtained
    • Bill using CPT 97124 (Therapeutic procedure, 15 minutes) and CPT 97140 (Manual therapy techniques, 15 minutes)
    • CPT code descriptions copyrighted by AMA; HCPCS by CMS
    Note

    Ensure the treating provider orders massage therapy and documents the referral in the medical record before services are rendered.

    • Referral/order must be from the treating physician

    Key Definitions

    Massage — definition and key attributes
    DefinitionMassage: rubbing or kneading part of the body, usually with the hands, to stimulate circulation and make muscles or joints suppler; includes soft tissue manipulation using hands or mechanical devices and techniques such as Shiatsu, Rolfing, Swedish, reflexology, myofascial release, craniosacral therapy, and Bindege webs massage.
    Included techniquesSoft tissue and manual techniques including friction, kneading, hacking, petrissage, neuromuscular techniques, trigger/pressure point work, and other manual modalities.
    Typical useApplied to a specific region (e.g., lumbar) or whole body, usually as an adjunct to other physical treatments but sometimes as the sole intervention.
    ContraindicationsNot appropriate with acute inflammation, skin infections, unhealed fractures, or burns.
    Provider qualifications (WA)Massage therapists are licensed by the state of Washington; licensure requires a minimum of 500 hours of training at an accredited school of massage therapy.

    Clinical Background

    Massage therapy is commonly used as an adjunct to other physical treatments and may increase muscle blood flow, enhance muscle tone, reduce muscle fatigability, improve muscle endurance, relax the mind, and raise the pain threshold. It typically involves rubbing or kneading soft tissues (hands or mechanical device) and includes techniques such as Shiatsu, Swedish, myofascial release, and trigger/pressure point work. Massage is contraindicated in the presence of acute inflammation, skin infections, unhealed fractures, and burns, and Washington state licensure requires a minimum of 500 hours of training for massage therapists.

    Policy Summary
    PayerKaiser Permanente
    PolicyMassage therapy coverage
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective DateN/A
    Last ReviewNov 5, 2024
    Next Review DateN/A
    Key ActionObtain a treating physician order and document assessment, diagnosis, objective limitations, expected improvement, and therapeutic benefit when requesting massage therapy.
    SourceLink
    On This Page
    Medical Necessity and Coverage RulesBillable Codes and Coding GuidanceReferral, Documentation, and Billing RequirementsKey DefinitionsClinical Background
  1. Confirm massage is a covered benefit under the member's Evidence of Coverage
    2. Documentation Required

    Required documentation

    Required documentation includes an assessment and diagnosis documenting objective physical and functional limitations, and a treating physician's order indicating expected meaningful improvement within a reasonable period.

    • Assessment and diagnosis documenting objective physical and functional limitations
    • Treating physician order documenting expectation that massage will provide therapeutic benefit and lead to significant improvement
    • Document progress toward therapeutic goals to support continuation of services
    Denial Risk

    Common denial triggers

    Massage is not covered for prevention, spa/recreational purposes, stress reduction, maintenance of current function, or when therapeutic goals have been met or there is no meaningful progress.

    • Not covered: prevention, recreation/spa therapy, stress reduction
    • Not covered: maintenance of current level of functioning
    • Not covered: patient has achieved therapeutic goals or is not showing meaningful progress