Massage Therapy Guidelines

Massage therapy is medically necessary for musculoskeletal conditions and only for two non‑musculoskeletal conditions (cancer pain and fibromyalgia); maintenance, preventative, palliative uses, services for other non‑musculoskeletal disorders, duplicate care, excessive frequency/duration, unaddressed red flags, or inadequate documentation (including unsupported retrospective claims) are excluded. Key requirements: current documentation must show a direct therapeutic relationship, addressed red flags, quantified pain/ADL deficits using standardized assessments with an expectation and evidence of measurable improvement (or documented exacerbation/MCID‑MDC improvement for continuation), confirmation of medical diagnosis (and oncologic co‑management for cancer), treatment by a qualified provider, and adherence to administrative submission timeframes.

"Massage Therapy Services will be considered Medically Necessary when current information is submitted to demonstrate that ALL of the following criteria have been met:"