Does Highmark Health Cover Massage Therapy?

Q: Can a chiropractor or PT bill separately for massage and manipulation on the same day?

Sometimes. Massage (97124) and manual therapy (97140) are considered inherent to manipulation when performed on the same body region and date and are not separately reimbursable. When provided to a different body region and billed with modifier 59, they may be considered for separate payment if documentation supports this.

Q: Is massage therapy ever covered under Highmark Medicaid or CHIP?

Highmark Medicaid and CHIP plans generally do not cover stand-alone massage therapy. However, soft-tissue work may be included within approved physical or occupational therapy sessions when medical necessity and prior authorization requirements are met.

Updated: November 14, 2025

Reviewed by: Dr. Donald L. Aivalotis, II

This guide explains whether Highmark Health plans cover massage therapy, including medical necessity rules, coverage limitations, provider requirements, and pre-authorization criteria. It summarizes Highmark’s commercial, Federal Employee Program (FEP), Medicare Advantage, Medicaid/CHIP, ACA/Marketplace, and self-funded (ASO) plans.

Does Highmark Commercial Insurance Cover Massage Therapy?

Sometimes — but usually only when massage is part of a medically necessary physical medicine or chiropractic treatment plan, not as a stand-alone spa service.

Highmark’s commercial medical policies treat massage as a physical medicine modality or as a component of manipulation therapy, not as a separate wellness benefit. In several policies, massage and joint mobilization (for example, CPT 97124 and 97140) are considered inherent parts of manipulation when performed on the same body region and same date of service, and are not eligible for separate payment.^1,2

Highmark’s manipulation therapy policy notes that manipulative therapy may include therapeutic massage, exercises, traction, neuromuscular re-education, and other procedures, as long as the service is delivered to treat defined musculoskeletal disorders and to restore lost function, not for maintenance or convenience.³

Unattended massages that do not require the services of a professional provider are specifically listed as non-covered services.¹

When Is Massage Therapy Covered Under Highmark Commercial Plans?

Massage-related services may be covered when:

They are provided as part of a physical medicine or chiropractic manipulation treatment plan for a musculoskeletal condition.
They are billed with appropriate therapy or manipulation codes (for example, 97124, 97140) by eligible providers.
The services are skilled, goal-directed, and expected to restore or significantly improve function, as required in Highmark’s physical medicine guidelines.⁴
Documentation supports medical necessity, including diagnosis, severity, functional impairment, and a written treatment plan.^2,4

When massage (97124) or joint mobilization/manual therapy (97140) is performed on a separate body region from the manipulation, Highmark policy allows those procedures to be considered for separate payment if billed with modifier 59 and properly documented.²

When Is Massage Therapy Not Covered Under Highmark Commercial Plans?

According to Highmark’s physical medicine and manipulation policies, massage is not covered when it is:

Performed solely for relaxation, stress relief, or personal lifestyle enhancement.⁵
Provided as an unattended massage that does not require professional skill.¹
Part of ongoing maintenance care after the patient has reached maximum medical improvement.^2,5
Performed without an appropriate diagnosis, plan of care, or functional goals.

Coverage is always subject to the member’s specific benefit plan, including visit limits and cost-sharing.^2,4

Does Highmark’s Federal Employee Program (FEP) Cover Massage Therapy?

Highmark administers the Blue Cross and Blue Shield Service Benefit Plan (FEP) in some regions. For FEP members, coverage for massage is determined by the Service Benefit Plan brochure issued by the Office of Personnel Management (OPM), not by a separate Highmark commercial policy.

Generally, the FEP brochure distinguishes between covered physical/occupational therapy and chiropractic services versus non-covered services such as massage performed solely for relaxation or personal comfort. Massage may only be considered when it is part of approved physical therapy or chiropractic treatment, and the brochure should be consulted for exact language and exclusions for the current year.

Because the FEP brochure is updated annually and applies nationally, FEP members should rely on the most recent brochure and contact FEP customer service for confirmation of massage benefits.

Does Highmark Medicare Advantage Cover Massage Therapy?

Highmark’s Medicare Advantage plans follow Medicare coverage rules, including National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), supplemented by Highmark’s own Medicare Advantage medical policies.^6,7

Under traditional Medicare, massage billed under CPT 97124 is generally not covered as a stand-alone service. Some LCDs allow limited use of massage within a covered physical therapy plan when it contributes to restoration of function, but it is not covered when performed solely for comfort or relaxation.⁶

Highmark’s Medicare Advantage policy search notes that MA coverage follows CMS rules. That means:

Massage is not covered for general wellness or relaxation.
Any massage-type service has to fit within covered PT/OT services and follow CMS documentation requirements (diagnosis, goals, progress, time-based coding).^6,7
MA plans may have strict utilization management and visit limits for therapy.

Members should use Highmark’s Medicare Advantage policy search and their plan’s Evidence of Coverage to confirm how physical therapy and massage-type services are handled for their specific contract.

Does Highmark Medicaid / CHIP Cover Massage Therapy?

Highmark Medicaid and CHIP plans (for example, Highmark Health Options) are governed by a combination of state Medicaid rules and Highmark therapy reimbursement policies.

Therapy reimbursement policies for Highmark Health Options describe prior-authorization requirements and unit limits for physical, occupational, and speech therapy visits. These policies emphasize medical necessity, functional goals, and time-based coding for each 15-minute unit of service.^8,9

Massage-type services are typically considered part of physical medicine or rehabilitation rather than a separate covered benefit. In most Medicaid and CHIP products, stand-alone massage therapy is not covered, but soft-tissue techniques may be included within covered PT/OT sessions when medically necessary and authorized.

Medicaid coverage varies significantly by state. Providers and members should use the plan’s prior authorization list and Medicaid provider manuals to confirm whether any massage-related codes are covered under therapy benefits in their state.^8,9

Does Highmark ACA / Marketplace Coverage Include Massage Therapy?

Highmark ACA/Exchange plans (on- and off-Marketplace) generally apply the same commercial medical policies used for fully insured plans. That means massage is treated as a physical medicine modality or part of manipulation services, subject to the same rules discussed in the commercial section.^4,10

Marketplace plans must cover essential health benefits such as rehabilitative and habilitative services, but they are not required to cover stand-alone massage therapy as a separate essential health benefit. As a result:

Massage is usually only considered when part of a covered PT/OT or chiropractic treatment plan.
Unattended or spa massage is excluded.
Visit limits and prior authorization rules may be stricter than some large-group commercial plans.

Members should review their ACA plan’s Summary of Benefits and Coverage and check Highmark’s online medical policy search to confirm how physical medicine codes are treated for their specific metal level (Bronze, Silver, Gold, etc.).⁴

Does a Highmark Self-Funded (ASO) Plan Cover Massage Therapy?

Self-funded (ASO) employer plans administered by Highmark use Highmark’s medical policies as guidance, but the ultimate coverage decision rests with the employer’s benefit design.

In most ASO plans:

Massage-type services follow Highmark’s physical medicine and manipulation policies for medical necessity and coding (97124, 97140, etc.).^1,2,3
Employers may choose to mirror standard Highmark exclusions (no stand-alone massage) or add carve-outs or wellness programs.
Some ASO plans add separate wellness or musculoskeletal programs that may provide discounted or alternative soft-tissue services outside the core medical benefit.

Because ASO benefits are highly customized, the member’s Summary Plan Description (SPD) and employer HR/benefits office are the most reliable sources for whether massage is covered or excluded in a particular self-funded plan.

How to Check Your Highmark Plan for Massage Therapy Coverage

To verify whether massage therapy is covered under a Highmark-administered plan:

Review your plan’s Evidence of Coverage, Summary of Benefits and Coverage, or FEP brochure (for federal employees).
Ask your physical therapist, chiropractor, or referring provider to check benefits and any prior authorization requirements for codes like 97124 and 97140.
Use the Highmark Medical Policy Search to review physical medicine, manipulation, and therapy policies for your region.⁴
Call the member services number on your Highmark ID card for plan-specific answers.

Frequently Asked Questions

Does Highmark cover massage at a spa or massage clinic?
No. Highmark policies describe unattended or relaxation massage as non-covered. Massage is only considered when it is part of medically necessary physical medicine or chiropractic care.^1,5

Can a chiropractor or PT bill separately for massage and manipulation on the same day?
Sometimes. Highmark policy states that massage (97124) and manual therapy (97140) are inherent to manipulation when performed on the same body region and date, and not separately reimbursable. When performed on a different region and properly documented, they may be considered separately with modifier 59.²

Does Highmark Medicare Advantage follow different rules for massage?
Highmark Medicare Advantage follows CMS rules, which generally do not cover stand-alone massage. Limited massage-type services may be included within covered PT under strict Medicare criteria, not for relaxation or wellness.^6,7

Is massage therapy ever covered under Highmark Medicaid or CHIP?
Typically not as a stand-alone benefit. Soft-tissue techniques may be included in approved therapy visits when medically necessary and authorized, according to state Medicaid and Highmark therapy reimbursement policies.^8,9

References

Highmark. Physical Medicine Modalities medical policy – notes that joint mobilization and massage are considered inherent parts of manipulation and that unattended massages are non-covered services (e.g., policy Y-9-032 / related bulletins).¹
Highmark. Manipulation Services – General Policy Guidelines – describes treatment plans, medically necessary manipulation, and when codes 97010, 97124, and 97140 may be separately payable with modifier 59.²
Highmark Commercial Medical Policy. Manipulation Therapy – states that manipulative therapy may include therapeutic massage and related procedures for musculoskeletal disorders.³
Highmark. Physical Medicine / Physical Therapy Medical Policy and related guidelines – outline documentation, visit limits, and medical-necessity requirements for therapy services.⁴
Highmark. Manipulation and Chiropractic Manipulation – Non-Covered Indications – notes that manipulation for relaxation or lifestyle enhancement is considered not medically necessary.⁵
Centers for Medicare & Medicaid Services (CMS). Outpatient Physical and Occupational Therapy Services – defines CPT 97124 (massage) and its coverage limitations under Medicare.⁶
Highmark. Medicare Advantage Medical Policy Search – states that Highmark Medicare Advantage adheres to CMS coverage determinations.⁷
Highmark Health Options. Therapy Policy Reimbursement – describes prior authorization and reimbursement rules for therapy visits, including unit limits.⁸
Highmark Health Options. Provider Manuals and Medicaid Medical Policies – outline coverage, documentation, and authorization requirements for therapy services.⁹
Highmark. Medical Policy Search Portal – central access point for commercial and Medicare Advantage medical policies.⁴