Massage Therapy Guidelines

Covered: massage therapy is medically necessary only to evaluate, diagnose, or treat pain or loss of function from musculoskeletal conditions or when primarily and directly treating the included non‑musculoskeletal conditions (Cancer pain and Fibromyalgia); excluded are maintenance, palliative, preventive services, treatment for other non‑musculoskeletal disorders, care unrelated to the region of complaint, excessive frequency/duration, services unlikely to produce measurable improvement, and care in the presence of red‑flag/life‑threatening findings. Key requirements: documentation that symptoms are musculoskeletal (or focused on cancer pain/fibromyalgia), quantified pain scores and ADL deficits, standardized assessment results (with MCID/MDC evidence or demonstration of exacerbation for continuation), oncology co‑management for cancer pain, formal fibromyalgia diagnosis, and appropriate behavioral‑health referrals when indicated.

"Medically necessary Massage Therapy Services are those that are reasonable and necessary, based on Generally Accepted Standards of Practice, for the evaluation, diagnosis, and treatment of a condit..."