Massage Therapists

Massage Therapy can help with pain relief and management, and can be a big part of resolving many musculoskeletal injuries and conditions. Many organizations are calling for alternative options for pain such as massage therapy among other therapies, yet the massage professional associations are not doing much to stand up for the profession in the medical arena. Meanwhile in WA State, massage therapists have been able to bill health insurance for the many pain related injuries and conditions.

In 2010, The Affordable Care Act opened the doors with Section 2706 that said insurance companies “shall not discriminate”against any health provider with a state-recognized license. Section 5101 includes licensed complementary and alternative medicine providers and integrative health practitioners in its definition of health professionals in the“health care workforce.” Yet nothing was done by any of the massage therapy associations.

In 2011, Relieving Pain in America:(PDF) A Blueprint for Transforming Prevention, Care, Education, and Research said reviews of research on acupuncture, massage, and chiropractic spinal manipulation for chronic low back pain suggest these therapies may be beneficial.

In 2016, the CDC even said:

Although there are perceptions that opioid therapy for chronic pain is less expensive than more time-intensive nonpharmacologic management approaches, many pain treatments, including acetaminophen, NSAIDs, tricyclic antidepressants, and massage therapy, are associated with lower mean and median annual costs compared with opioid therapy. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016

In Feb 2017, the National Association of Attorney Generals, issued this letter (PDF), asking for alternatives to Opioids be considered to help end the epidemic.

When patients seek treatment for any of the myriad conditions that cause chronic pain, doctors should be encouraged to explore and prescribe effective non-opioid alternatives, ranging from non-opioid medications (such as NSAIDs) to physical therapy, acupuncture, massage, and chiropractic care.

In Jan 2018, the Academy of Integrative Pain Management (AIPM) and the US Pain Foundation, wrote a letter to the U.S. Senate Committee on Finance (the Committee with jurisdiction over the Centers for Medicare and Medicaid Services, or CMS), asking them to cover massage therapy.

The Joint Commission has also previously called for coverage of massage therapy in 2015(PDF)

Revised Rationale for PC.01.02.07 (New for Ambulatory Care and Office-Based Surgery Practice)

The identification and management of pain is an important component of [patient]-centered care. [Patients] can expect that their health care providers will involve them in their assessment and management of pain. Both pharmacologic and nonpharmacologic strategies have a role in the management of pain. The following examples are not exhaustive, but strategies may include the following:l Nonpharmacologic strategies: physical modalities (for example, acupuncture therapy, chiropractic therapy, osteopathic manipulative treatment, massage therapy, and physical therapy), relaxation therapy, and cognitive behavioral therapyl

and again in 2017

When a patient’s preference for a safe nonpharmacologic therapy cannot be provided, hospitals should educate the patient on where the treatment may be accessed post-discharge. Nonpharmacologic strategies include, but are not limited to: physical modalities (for example,

acupuncture therapy, chiropractic therapy, osteopathic manipulative treatment,massage therapy, and physical therapy), relaxation therapy, and cognitive behavioral therapy.

In April 2017, the American College of Physicians did a study to systematically review the current evidence on nonpharmacologic therapies for acute or chronic nonradicular or radicular low back pain and here is their recommendation:

Recommendation 1: Given that most patients with acute or subacute low back pain improve over time regardless

of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-

quality evidence),massage, acupuncture, or spinal manipulation (low-quality evidence). https://www.ncbi.nlm.nih.gov/pubmed/28192793

In April 2017, Federation of State Medical Boards April 2017 adopted their policy on Chronic use of Opioids and recommended:

The treatment plan may contain information supporting the selection of therapies, both pharmacologic (medications other than opioids to include anti-inflammatories, acetaminophen, and selected antidepressants and anticonvulsants) interventional, and non-pharmacologic therapies such as cognitive behavioral therapy,massage, exercise, multimodal pain treatment, and osteopathic manipulative treatment. The plan should document any further diagnostic evaluations, consultations or referrals, or additional therapies that have been

considered to the extent they are available.

In Oct 2017, the first Integrative Pain Policy Conference was held in San Diego. The AMTA was invited and was supposedly there according to the report from the Academy of Integrative Pain Management, but to date I have not heard any report from the AMTA.

The Congressional Integrative Health and Wellness Caucus held on March 15, 2015 calls for:

The mission: “Amidst Opioid Crisis: New Caucus Will Focus on Integrative Health Solutions.”

Make sure you contact your legislative representative and ask them to JOIN.

Medicare Managed Care Manual Chapter 4 – Benefits and Beneficiary Protections. Revised for 2019 coverage Year also calls for more massage therapy as an alternative to Opioids.

Medically-Approved Non-Opioid Pain Management (PBP B13d, e, or f ): 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).
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/mc86c04.pdf

Massage Therapists are licensed as Health Care Providers in over 20 states. This is the list that I have so far, collected from various Facebook Groups so check the sources and let me know of any corrections.

AL, CO, CT, FL, GA, LA, MI, MD (LMTs only) MO, NC, NM, NY, OH, OR, TN, VI, WA, Wa DC, WI, WV, WY.

In most states, massage therapists can bill for car accident related injuries and for work related injuries.

With so much interest and backing from prominent organizations calling for
massage therapy to become part of the answer to the Opioid Epidemic, where is the Massage Therapy Profession?

Why are we so far behind in being recognized by medical professionals and health insurance companies?

The reason is that no one or no organization is standing up for us in this arena. It is also a dual edged sword working with insurance companies as they are constantly reducing benefits and allowable fees making it more difficult to make a living billing health insurance. But again, no one has been representing massage therapists at the table talking to the insurance companies. It is up to You now!

Find out if you are licensed as a health care professional. Please find the link to a page in your laws that show that massage is licensed as a health care profession in your state and share in the comments.
Look at what has been done in WA State in this arena. They have been able to bill health insurance since about 1996 because of a law called the Every Category Law that was put into place after a long battle with the insurance companies that wanted to stop it. There is even a supreme court decision making it into law.
Why is the Massage Profession so far behind? Healthcare Integration for Massage Therapists on www.massagepracticebuilder.com
Time line of events in implementing the Every Category Law in WA State – Report of the Clinician Workgroup on the Integration of Complementary and Alternative Medicine January 2000. Washington State.
Find out what is happening in your state on creating a different law that would make health insurance companies cover massage.
Find out what your AMTA chapter is doing.
Here is a list of them on Facebook. https://www.facebook.com/lists/10151631915757567
Here is a list of them on the AMTA website: http://www.amtamassage.org/chapters/index.html
Many of the AMTA Chapters are not currently doing anything but a few are. OH, WI, WV are working on getting laws passed that include coverage for massage therapy. The National Medical Massage and Bodywork Association is working on CO issues.
If your AMTA Chapter is not working on anything and they are not interested in working on anything – Start your own separate state organization – like WA did – WA State Massage Therapy Association. We started this because we have been involved in billing health insurance for over 20 years in WA State and the current AMTA leadership has said that they can’t get involved in health insurance issues. No one has been at the table for us and in the past 6 years or so – the insurance companies have been constantly reducing our allowable fees making it more difficult to make a living billing health insurance.
Find out what your Insurance commissioner needs and start the conversation with them about getting massage integrated into healthcare. http://www.naic.org/state_web_map.htm
Write a letter to be sent to the OIC in your state. You will need this info for the OIC and use the above requests for massage therapy to be incorporated into healthcare along with these papers:
MASSAGE THERAPY IN INTEGRATIVE CARE & PAIN MANAGEMENT (PDF) Published by the American Massage Therapy Association

The Value and Efficacy of Massage therapy. Published by the American Massage Therapy Association

Summary of Evidence (PDF) – How massage fits into the Essential Health Benefits (Created by AMTA-WA)

Adequacy: http://familiesusa.org/product/network-adequacy-101-explainer?hc_location=ufi
Write a letter that clients can send to their insurance company asking for massage therapy to be covered.
Write a letter that clients can use to send to the OIC.
See also: www.covermycare.org http://www.covermycare.org/cmc/the-cmc-toolkit/
You will also need a Political Action Committee. WA State has one that was started in about 2005 to help support candidates who support massage therapy – WA Massage Alliance for Health (www.wamah.org) Our Every Category Law constantly needs protection and to get anywhere with healthcare, you need a PAC. Oh and why don’t we have a National PAC???

So there you have enough to get yourself started. Join my closed Facebook Group : Health Care Integration for Massage Therapists to continue the discussions and start creating plans.

Learn to bill Insurance for massage therapy with the new 2019 Edition of Massage Insurance Billing – Healthcare Integration and Advocacy