Massage Therapy Guidelines

Covered when massage is therapeutic for a primary neuromusculoskeletal injury/illness (e.g., neck, back, shoulder, limb, ankle/foot, fibromyalgia) provided by a participating massage therapist (up to 60 minutes/visit); excluded are preventive/maintenance care, services by non‑participating providers (except emergencies or eviCore‑authorized), experimental treatments, supplies, TENS/electrical modalities, techniques outside state scope, and other listed exclusions. Key requirements: documented medical necessity with ≥1 functional limitation and ≥1 subjective complaint from specified regions, objective musculoskeletal exam findings, numeric pain scores (0–10), recommended use of PSFS, pre‑authorization where required, documented progress per specified timelines for continued coverage, and immediate medical referral for red‑flag signs.

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