Is Massage Therapy Covered?
Yes.
Aetna covers massage therapy when it is deemed medically necessary and is part of a physical therapy treatment plan. Coverage typically applies when massage therapy is part of a treatment plan prescribed by a physician for certain medical conditions.
For example, if a patient is recovering from a sports injury, their physical therapy plan may include massage therapy to help reduce muscle tension and promote healing. Massage is then an adjunct procedure to the primary physical therapy. If the massage therapy is prescribed by a qualified health professional and is part of the physical therapy plan of care, it would likely be covered by Aetna.
Aetna does not consider massage therapy as medically necessary for longer than 2 weeks. The coverage is typically limited to the initial or acute phase of an injury or illness, specifically within an initial 2-week period.
This means that extended massage therapy treatments will not likely be covered under Aetna’s policies.
In most cases, massage is NOT COVERED in a massage therapy office. Aetna does not recognize massage therapists as licensed providers under their policy guidelines.
What Conditions Must Be Met for Massage Therapy Coverage?
Massage therapy is covered when:
- It is prescribed by a licensed physician or other healthcare provider.
- It is part of a documented treatment plan for a specific medical condition.
- The therapy is provided by a physical therapist as part of a care plan.
- The medical necessity and effectiveness of the treatment are clearly documented.
Does Massage Therapy Need Pre-Authorization?
Yes.
In many cases, massage therapy requires pre-authorization from Aetna. This means that your healthcare provider must submit a request to Aetna, including the treatment plan and documentation supporting the medical necessity of the therapy.
Are There Limits to Massage Therapy Coverage?
Yes.
There are limits. Aetna may have specific restrictions on the number of sessions covered per year and the conditions for which massage therapy is deemed appropriate. It is important to check your specific plan details to understand these limits.
This means that you will not get a 1-hour massage covered by Aetna. Massage is only covered when a part of a larger physical therapy plan.
How Do I Get Pre-Authorization for Massage Therapy?
To get pre-authorization, your healthcare provider will need to submit a request to Aetna. This request should include your diagnosis, the treatment plan, and documentation of medical necessity. Once submitted, Aetna will review the request and determine if the therapy is covered under your plan.
Is a Referral Needed from My Primary Care Physician (PCP)?
Maybe.
It depends on your specific Aetna plan. Some plans may require a referral from your PCP, while others may allow you to directly seek treatment from a physical therapist. It is best to check your plan’s requirements or contact Aetna customer service for clarification.
Are There Specific Providers I Need to See for Coverage?
Yes.
Aetna usually requires you to see a licensed physical therapist who is within their network. Using an in-network provider ensures that you receive the maximum benefits available under your plan.
You can find in-network providers by checking Aetna’s provider directory.
What Documentation is Needed for Coverage?
To ensure coverage, the following documentation is typically required:
- A prescription or referral from a licensed physician.
- A detailed treatment plan outlining the medical necessity of massage therapy.
- Progress notes from the massage therapist documenting the effectiveness of the treatment.
Can I Get Reimbursed for Out-of-Network Massage Therapy?
If you receive massage therapy from an out-of-network provider, you may still get some reimbursement, but it will typically be at a lower rate than for in-network services. It’s important to check your specific plan details and understand the reimbursement process for out-of-network care.
Where Can I Find More Information?
For more detailed information, you can visit Aetna’s official website and review their coverage policies or contact Aetna customer service directly.
Aetna Massage Therapy Coverage Guidelines: http://www.aetna.com/health-care-professionals/clinical-policy-bulletins/massage-therapy-guidelines.html (This is a placeholder URL. Please replace it with the actual link if available.)
Remember to always verify coverage details directly with Aetna, as specific benefits can vary depending on your plan and location.