Medicare-Maine... Is Massage Covered?

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Permalink Reply by Neal Lyons on April 9, 2014 at 1:36pm

Jessica - This is based on statutory law. In jurisdictions where it is covered, it must be a referral by a doctor/chiro/therapist.

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Permalink Reply by Jessica Belanger on April 10, 2014 at 6:54am

But how do you find out if it is covered? Thats why I was hoping a therapist from Maine who deals with insurance can give me a straight answer. I went to the medicare.gov site and it says Massage is not covered..so I would think if it was a state choice it would state that on their site. Plus I have found no real way to speak with anyone from Medicare? I need a real answer. 

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Permalink Reply by Jody C. Hutchinson on April 10, 2014 at 7:37am

JB,

I have been practicing in California for over 25 years. I have only been able to bill for car accidents and injured workers. I called Medicare several years ago after someone called and insisted that Medicare covered massage. When I called they said massage was NOT covered. I worked in a MD/DC office for over 14 years and there were few Medicare patients who got massage. There was some noise years ago about Medicare covering a 30 minute treatment for back pain. I think it died. I can't understand why you can't reach anyone by phone....

JH

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Permalink Reply by Neal Lyons on April 16, 2014 at 1:09pm

Have you tried visiting the local Health and Human Services offices out of which Medicare is administered? Perhaps you can ask directly and see if someone is able to assist. Another, albeit more aggressive way to find out is to bill them directly and see what they do. Denied claims will be accompanied by a reason/code.

Jessica Belanger said:

But how do you find out if it is covered? Thats why I was hoping a therapist from Maine who deals with insurance can give me a straight answer. I went to the medicare.gov site and it says Massage is not covered..so I would think if it was a state choice it would state that on their site. Plus I have found no real way to speak with anyone from Medicare? I need a real answer. 

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Permalink Reply by Ariana Vincent, LMT, MTI, BCTMB on May 5, 2014 at 10:40pm

Here's a response from Joseph Matthews at caring.com:  "Some massage therapy might be covered by Medicaid (which often provides broader coverage than Medicare does). But Medicaid is not the same in every state. Each state Medicaid program has somewhat different rules about what kinds of medical care are covered and how someone would qualify to receive that care.

If your state's Medicaid program does cover some medical massage therapy, there will be significant restrictions on it. In the first place, it almost certainly will require a referral from a physician, as well as ongoing supervision by the physician if there are to be repeated therapy sessions. It may also require prior authorization from Medicaid itself. If you are approved to receive massage therapy, you must receive it from a therapist who participates in the Medicaid program, which means the therapist is certified by Medicaid and accepts Medicaid patients. Also, there may be a limit on the number of visits Medicaid will pay for, or on the total amount Medicaid will pay.

To find out whether your state's Medicaid program covers massage therapy, and to learn the rules for coverage if it does, go online to any search engine and enter the word Medicaid and the name of your state. Once you get to the web site, enter "massage therapy" in the site's search tool. Or, you can call the Eldercare Locator toll-free at 800-677-1116 to get the number of your state Medicaid office, and ask them about massage therapy coverage."

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