Massage Therapy
EVICORE-MSK_THERAPIES-B4209D8B
Covered: medically necessary massage therapy for symptoms directly caused by a primary neuromusculoskeletal injury/illness (including ankle/foot pain and fibromyalgia) when delivered by a participating massage therapist (≤60-minute sessions); excluded are preventive/maintenance or experimental care, services by non‑participating providers, certain modalities/supplies (e.g., TENS), conditions covered by workers’ comp/auto insurance, and red-flag situations (e.g., suspected DVT, fracture, infection). Key requirements: pre-authorization is required except for initial visits or emergencies, and detailed clinical documentation must demonstrate numeric pain scores, at least one subjective complaint and one functional limitation, recommended PSFS functional measures, exam findings, and time‑based progress per benchmarks or therapy will be denied as not medically necessary.
"Massage Therapy for injury or illness for which massage has a therapeutic effect."