How to Get Medically Cleared for Medical Massage
A patient guide to referrals and insurance verification. Medical massage may be recommended as part of your healthcare plan for pain management, injury recovery, post-surgical care, lymphatic concerns, and musculoskeletal dysfunction.
Understanding "In Lieu of Services"
Did you know that some insurance plans offer alternative therapies as a substitute for traditional treatments? This is often referred to as "In Lieu of Services."
Example: Carolina Complete Health
Carolina Complete Health offers services or settings that are medically appropriate, cost-effective substitutions for services covered by NC Medicaid. These are called in lieu of services.
These services are extra supports to improve your health if you need them. Carolina Complete Health will work with you and/or your authorized representative to connect you to these services, resources, and social services. You are not required to use in lieu of services. Carolina Complete Health offers the following in lieu of services:
- Massage therapy in lieu of opioid pain management: Massage therapy as a method of managing pain instead.
How to Use Your Benefits for Medical Massage
Even if we are not officially "in-network" with your specific carrier, you may still be able to utilize your benefits. Here is how to navigate your plan:
Call Member Services
Call the number on the back of your insurance card. Ask specifically about "In Lieu of Services" or alternative pain management benefits for massage therapy.
Check Requirements
Ask what documentation is required. You will almost always need a prescription or referral from your primary care provider.
Verify Out-of-Network
If we are not in-network, ask if you have "out-of-network" benefits that can be applied toward medical massage.
Use Official Resources
Log into your member portal to read your official benefits handbook and access necessary reimbursement forms.
Important Note: This information is for educational purposes. Valor Massage is an independent provider. Please consult your official insurance handbook or member portal for your specific coverage details. Do not assume in-network status unless explicitly confirmed by your carrier.
General Steps for Medical Clearance
Contact Your Insurance Company
Coverage varies by plan. Call the member services number on your insurance card and ask: Do I have benefits for medical massage or manual therapy? Is prior authorization required? Do I need a referral on file? What services are covered? What are my estimated out of pocket costs? Write down the representative's name, reference number, and details.
Speak With Your Medical Provider
Schedule an appointment with your primary care provider or specialist. Explain your symptoms clearly, including pain, swelling, nerve issues, mobility limits, injuries, or surgical history. Ask whether medical massage or manual therapy would be appropriate for your condition. Some insurance plans require a referral or prescription.
Request Documentation (If Required)
If your provider agrees, they may provide a referral or prescription that includes diagnosis, treatment frequency, and length of care. This allows your healthcare providers to coordinate services.
Choose a Licensed Medical Massage Provider
Look for clinics that work with medical referrals, maintain clinical documentation, coordinate with providers, and have experience with injury or recovery care. Not all massage is medical in nature.
Submit Your Referral to the Clinic
Once received, many clinics assist with benefit verification and next steps. This helps streamline care and avoid delays.
If Insurance Does Not Cover Services
Patients may still use cash medical rates, package options, HSA or FSA funds, and superbills for possible reimbursement. Ask your provider about available options.
Important Notice: Coverage and eligibility are determined by your insurance carrier. This guide is for educational purposes only and does not guarantee coverage.
Frequently Asked Questions
Do you bill my insurance directly?
With the exception of VA Community Care (where we are an authorized provider), we are typically an out-of-network provider. We can provide you with a detailed "superbill" that you can submit directly to your insurance company for potential reimbursement.
Can I use my HSA or FSA?
Yes! We accept all major Health Savings Account (HSA) and Flexible Spending Account (FSA) cards. Medical massage is generally an eligible expense, especially with a letter of medical necessity from your doctor.
What if I don't have a referral?
You can still book a session! Referrals are primarily needed if you are seeking insurance reimbursement or using certain HSA/FSA funds. You are always welcome to pay out-of-pocket for any of our services.
Ready to Schedule?
Whether you are using insurance, HSA/FSA, or paying out-of-pocket, we are ready to support your recovery.
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