Massage Therapy Guidelines

Covered when reasonable and necessary to reduce pain or restore function for musculoskeletal conditions and specifically for cancer‑related pain (as an adjunct to oncologic care) and fibromyalgia; excluded for maintenance, preventive or palliative use, non‑musculoskeletal disorders (except the two listed), treatments lacking quantified pain/ADL deficits or measurable improvement, services with red‑flag conditions, recreational/sport performance without ADL deficits, excessive frequency/duration, or those that replace/delay other necessary care. Key requirements: documentation of etiology or condition‑specific focus, validated standardized assessment scores with quantified deficits and demonstrated improvement (or MCID/MDC for continuation), appropriate medical co‑management (oncology involvement for cancer), established fibromyalgia diagnosis, and mental‑health referral when indicated.

"Massage Therapy Services that are reasonable and necessary for evaluation, diagnosis, and treatment to reduce pain or restore lost function resulting from an injury or illness that is musculoskelet..."