Does Medical Mutual of Ohio Cover Massage Therapy?

Updated [November 14, 2025]

Reviewed by: Dr. Donald L. Aivalotis, II

This guide explains whether Medical Mutual of Ohio covers massage therapy, including medical necessity rules, coverage limitations, provider requirements, and pre-authorization criteria.

Is Massage Therapy Covered by Medical Mutual of Ohio?

In most Medical Mutual plans, massage therapy is excluded as a covered benefit.

Medical Mutual benefit books and member guides repeatedly list “massotherapy or massage therapy” under services that are not covered. For example, several plan certificates include an exclusion for “massotherapy or massage therapy,” and member FAQ documents state that excluded services typically include massage therapy along with items like convenience products, hypnosis, and most over-the-counter drugs.1,2,3

Some employer group plans administered by Medical Mutual add a narrow exception, stating that there is no coverage “for massotherapy or massage therapy, except as directly performed by a licensed physical therapist, occupational therapist or chiropractor.”4 In those plans, massage is only considered when it is part of a covered physical medicine or chiropractic service—not as a standalone benefit.

Medical Mutual’s Medicare Advantage benefits also list “Massage therapy: Not covered” in the summary of benefits, which means traditional massage is not offered as a Medicare Advantage supplemental benefit in those products.5

Because Medical Mutual administers many different employer, individual, exchange, and Medicare plans, members should always confirm details in their specific Benefit Book or Summary of Benefits and Coverage.

Medical Mutual’s Limitations on Massage Therapy

Across recent plan documents, Medical Mutual applies the following general limitations:

  • Massage therapy (massotherapy) is typically listed as an excluded service.1,2,3
  • Some employer plans allow an exception only when massage is directly performed by a licensed physical therapist, occupational therapist, or chiropractor as part of covered therapy or chiropractic care.4
  • Massage performed for relaxation, stress reduction, wellness, or comfort is not considered medically necessary.
  • Coverage is subject to each plan’s general limitations and exclusions section, not a separate “massage” benefit.

Even when a narrow exception exists, the service is treated as part of physical medicine, rehabilitation, or chiropractic benefits and must meet all documentation and medical-necessity criteria for those services.

When Can Massage Therapy Be Covered?

Massage-related services may be considered for coverage only in the limited plans that contain an explicit exception, typically worded like:

“For massotherapy or massage therapy, except as directly performed by a licensed physical therapist, occupational therapist or chiropractor.”4

In those plans, massage may be covered when:

  • It is delivered and billed by a licensed PT, OT, or DC under that provider’s therapy or chiropractic benefit.
  • It is part of a documented treatment plan (for example, rehabilitative PT for a musculoskeletal injury).
  • The service is aimed at functional improvement or restoration, not maintenance or comfort only.
  • All other therapy or chiropractic benefit rules (visit limits, medical necessity, etc.) are met.

Plans without this explicit language generally treat any massotherapy or massage therapy as fully excluded, regardless of who performs it.

Does Massage Therapy Require Pre-Authorization?

Massage itself is usually excluded, so pre-authorization does not apply to stand-alone massage.

However, Medical Mutual does require pre-authorization and treatment plans for many therapy services (physical therapy, occupational therapy, speech therapy, and chiropractic care) in commercial and exchange plans. PT/OT/chiropractic authorization forms and prior approval lists are published on the Medical Mutual provider website.6,7,8

If a plan includes the “except as directly performed by a PT/OT/DC” exception, any soft-tissue or massage-like work would be reviewed as part of the underlying therapy or chiropractic service. In that case, medical necessity, visit limits, and any pre-authorization requirements for PT/OT/DC would still apply.

Massage Therapy That Is Not Covered

Under most Medical Mutual plans, the following are not covered:

  • Massage therapy or massotherapy listed in the general “Exclusions” section of the Benefit Book.1,2,3,9,10
  • Spa, salon, or wellness massage—even with a physician recommendation.
  • Massage performed purely for stress reduction, relaxation, or personal comfort.
  • Massage billed by an independent licensed massage therapist when there is no PT/OT/DC exception language.
  • Massage therapy under Medicare Advantage plans, which list “Massage therapy: Not covered” in their benefits summary.5

These exclusions apply regardless of whether the provider is in-network or out-of-network; excluded services are not payable under the plan.

How to Check If Your Plan Has a Massage Exception

Because benefit designs vary widely, you should:

  1. Locate your plan’s Certificate/Benefit Book or Summary Plan Description (SPD).
  2. Go to the “Exclusions” section and look for “massotherapy or massage therapy.”
  3. Check whether the exclusion includes the phrase “except as directly performed by a licensed physical therapist, occupational therapist or chiropractor” or a similar carve-out.4,9,11
  4. Review your physical therapy/chiropractic benefits for visit limits, co-pays, or pre-authorization rules.
  5. Call Medical Mutual Customer Care at the number on your ID card and ask specifically: “Is massage therapy ever covered under my plan, and if so, under what conditions?”

Providers can also verify benefits and limitations by contacting Medical Mutual Provider Inquiry or using their provider portal tools.

Does Medical Mutual Require a Referral?

Referral and authorization rules for therapy depend on the specific product (HMO, PPO, POS, exchange, employer group, self-funded, Medicare Advantage). Many plans:

  • Do not require a referral for in-network PT/OT in PPO designs, but still require pre-authorization after a certain number of visits.
  • May require primary-care referrals in HMO-style products.
  • Use medical-necessity criteria and internal clinical guidelines for therapy, but still exclude stand-alone massage therapy.6,7,12

Your Evidence of Coverage and SBC are the best sources for whether referrals are needed for therapy services under your specific plan.

Documentation Requirements (When Massage Is Part of Therapy)

In the rare plans that allow massage therapy when performed by a PT/OT/DC, the service must meet Medical Mutual’s general documentation expectations for therapy or chiropractic services, which include:6,8,12

  • An initial evaluation with diagnosis, impairment, and functional limitations.
  • A written treatment plan with goals, frequency, and duration.
  • Use of appropriate CPT codes for each modality (e.g., manual therapy vs. massage vs. therapeutic exercise).
  • Progress notes showing measurable improvements and reasons for continued care.
  • Compliance with any pre-authorization or continued-stay review requirements.

Even in those plans, massage that becomes purely maintenance, comfort-focused, or non-functional is likely to be denied.

Reimbursement for Out-of-Network Massage Therapy

Some Medical Mutual PPO plans offer out-of-network benefits. However:

  • Out-of-network coverage never overrides an exclusion; if “massotherapy or massage therapy” is excluded, it remains excluded even out-of-network.1,9,10
  • Only covered therapy or chiropractic services are eligible for reimbursement.
  • Members who choose to receive spa or stand-alone massage should expect to pay fully out-of-pocket.

Always confirm your out-of-network benefit details in your Benefit Book and with Customer Care if you plan to submit any claims.

Where to Find More Information

Key resources include:

  • Medical Mutual Corporate Medical Policies – guidance documents and clinical review criteria.12
  • Your plan’s Certificate/Benefit Book or SPD – look for the “Exclusions” section mentioning massotherapy or massage therapy.9,10,11
  • Member FAQ brochures (for example, “Member Guide – Frequently Asked Questions”), which list massage therapy as a typical excluded service.1,2,3

For plan-specific coverage questions, log into your My Health Plan account at MedMutual.com or call the number on your ID card.

Frequently Asked Questions

Does Medical Mutual cover massage therapy for stress or wellness?
No. Medical Mutual member guides list massage therapy as a typical excluded service. Stress or wellness massage is not covered.

Are there any Medical Mutual plans that cover massage?
Some employer plans include an exception that allows massotherapy when it is directly performed by a licensed PT, OT, or chiropractor as part of covered therapy. You must check your specific Benefit Book.

Does Medical Mutual Medicare Advantage cover massage therapy?
No. Recent MedMutual Advantage PPO benefit summaries list “Massage therapy: Not covered.”

Can I be reimbursed if I see a massage therapist and submit a claim myself?
In most cases, no. If massage therapy is excluded in your plan, Medical Mutual will not reimburse those charges even if you have out-of-network benefits.

References

  1. Medical Mutual of Ohio. Member Guide FAQ (Non-Rx) – Excluded services (massage therapy listed as a typical exclusion).
  2. Medical Mutual of Ohio. Member Guide / FAQ Brochures – excluded services section (massage therapy).
  3. Medical Mutual of Ohio. FAQ – What This Plan Does Not Cover – excludes massage therapy.
  4. Medical Mutual Plan Certificates and SPDs (e.g., Catholic Diocese of Cleveland, The Schroer Group) – exclusion: “For massotherapy or massage therapy, except as directly performed by a licensed physical therapist, occupational therapist or chiropractor.”
  5. MedMutual Advantage PPO Plan Summaries – benefit table row: “Massage therapy: Not covered.”
  6. Medical Mutual. Therapy Authorization Forms – PT/OT/chiropractic authorization requirements.
  7. Medical Mutual. Commercial Prior Authorization Requirements List – therapy-related prior approval categories.
  8. Medical Mutual. Physical and Occupational Therapy Code List – covered therapy CPT codes (not a separate massage benefit).
  9. Medical Mutual. Bronze and Silver HMO/Exchange Certificates – exclusions list “For massotherapy or massage therapy.”
  10. Medical Mutual. Off-Exchange and Group Certificates – exclusions section including massotherapy or massage therapy.
  11. Various employer SPDs administered by Medical Mutual – exclusions for massotherapy or massage therapy.
  12. Medical Mutual. Corporate Medical Policies and Clinical Review Guidelines.