Massage Therapy Guidelines

Covers manual, non‑electrical massage (up to 60 minutes per visit by a participating therapist) for primary neuromusculoskeletal conditions (e.g., headache, neck/back, extremity pain, fibromyalgia) and adjunct cancer care when active oncology co‑management is confirmed; excludes supplies, preventive/maintenance or investigational services, services by non‑participating providers, workers’ compensation/auto‑covered injuries, DVT, electrical devices (e.g., TENS), supplements, out‑of‑scope techniques, and services outside plan rules. Key requirements: documented medical necessity showing a primary neuromusculoskeletal diagnosis, ≥1 functional limitation and ≥1 subjective complaint, objective exam findings and 0–10 pain scores, per‑visit progress notes demonstrating improvement per specified week‑by‑week milestones, red‑flag screening, and pre‑authorization when required; lack of progress, noncompliance, or safety concerns results in denial or discharge.

"Massage Therapy for injury or illness for which massage has a therapeutic effect."