Massage Therapy Guidelines

Massage therapy is covered only for musculoskeletal conditions and select non‑musculoskeletal conditions (cancer pain, fibromyalgia) and is excluded for maintenance/preventive/palliative care, non‑included systemic disorders, care without quantified deficits, duplicate or excessive services, and inadequately documented or retrospective claims. Approval requires current documentation of a direct therapeutic relationship, standardized quantified pain or ADL deficits, red flags addressed, expectation of measurable improvement within a reasonable timeframe, confirmation of medical evaluation for non‑musculoskeletal cases and minors (oncology co‑management for cancer pain), and continuation requests must show an exacerbation or quantified improvement (e.g., MCID/MDC).

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