In the last year the Centers for Medicare and Medicaid Services (CMS) has issued two statements regarding medically-approved non-opioid pain management for Medicare Advantage (MA) plans. The clarifying memorandum: “Reinterpretation of ‘Primarily Health Related’ for Supplemental Benefits” includes a specific reference to the availability of massage therapy as an approved supplemental benefit for pain management:

Medically-approved non-opioid pain treatment alternatives, including therapeutic massage furnished by a state licensed massage therapist. “Massage” should not be singled out as a particular aspect of other coverage (e.g., chiropractic care or occupational therapy) and must be ordered by a physician or medical professional in order to be considered primarily health related and not primarily for the comfort or relaxation of the enrollee. The non-opioid pain management item or service must treat or ameliorate the impact of an injury or illness (e.g., pain, stiffness, loss of range of motion).

In the 2018 bulletin, this was merely a recommendation; but, by January 2019 CMS was strongly encouraging MA plans to offer therapeutic massage for pain management, furnished by a state licensed massage therapist, as a supplemental benefit.  

So, what does this mean for massage therapists?

First, we need to look at the difference between a Medicare Advantage plan and original Medicare.

Medicare Advantage (also known as Medicare Part C) includes both Part A (Hospital Insurance) and Part B (Medical Insurance) from original Medicare, but these plans are administered by private health plans and not through the U.S. Government (in this case, Medicare). The biggest differences between original Medicare and MA plans are that MA plans have a yearly limit on a covered person’s out-of-pocket costs, providers are limited to those in the MA plan, and most importantly, they may offer supplemental benefits such as vision, hearing, dental coverage or therapeutic massage furnished by a state licensed massage therapist not included in Part A or Part B. It’s important to remember that MA plans are not mandated to require supplemental benefits, but many do to make their plans more attractive to the beneficiary. These CMS recommendations are limited exclusively to MA plans.

Can all massage therapists expect to be reimbursed by Medicare plans for clients who are covered by Medicare?

Massage therapists currently are not recognized Medicare providers. MA plans can cover massage therapy by a state-licensed massage therapist who would meet the requirements of their plan for reimbursement.

Why is this an important step in the effort to fully incorporate a segment of massage therapy into the traditional health care system and increase recognition from health insurers?

CMS has a large influence over the health system, and health insurance companies are not immune to that influence.  CMS makes its decisions based on the best available evidence. Therefore, by making this recommendation they not only recognize the efficacy of massage therapy, but have gone beyond that to identify who should perform the service – a state licensed massage therapist – and that massage should not be singled out as a particular aspect of other coverage, such as chiropractic care or occupational therapy.

Not every massage therapist will want to work in a clinical environment or deal with third party reimbursement issues. However, the recommendations by CMS clearly show that massage therapy is valuable and effective for pain management and, more broadly, improving health. This recognition shines a light on all massage therapists and elevates the profession in the eyes of the public and those in the medical profession.

What do you do if you are interested in providing massage to people who are in Medicare Advantage programs?

First of all, you must be a state-licensed massage therapist. That means massage therapists in states without statewide licensure—including California, Kansas, Minnesota, Vermont and Wyoming—cannot be considered providers under these plans.

Second, massage therapists need to have a registered National Provider Identifier (NPI) number. The NPI is a unique 10-digit number that individually identifies all health care providers. This number gives federal and state agencies a way to determine the size and project impact on the health care system by the massage therapy profession. In other words, when government agencies that provide oversight make decisions on coverage, care and providers, for example, they look at the list of NPIs for a specific profession to identify the supply to meet the demand.

These are first steps. By 2020, the expectation is that many more Medicare Advantage programs will offer massage therapy coverage as insurers see the benefit and are encouraged by CMS to participate. All massage therapists should verify a client’s MA plan if they come to you for massage therapy and believe they are covered. Remember, too, the plans that do cover massage therapy by licensed massage therapists specifically cover massage for non-opioid treatment of pain.

How to Apply for a NPI

The National Provider Identifier (NPI) is a unique 10-digit number that identifies all health care providers individually. Health care providers, including massage therapists, are required to use the NPI when submitting HIPAA* standard electronic transactions including, but not limited to:

-Claims and encounter information

-Payment and remittance advice

-Member eligibility inquiry

-Claims status and inquiry

To apply for an NPI, create a new account at: https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart