Does Health Care Service Corporation (HCSC) Cover Massage Therapy?

Q: Why does prior authorization matter for massage therapy?

In many HCSC products, massage therapy codes are managed by utilization review vendors, so visits must be authorized to confirm medical necessity and benefit eligibility before they are covered.

Q: How can I find out if my specific plan covers massage therapy?

Members should review their benefit booklet, log in to their Blue Cross and Blue Shield plan account, or contact the customer service number on their ID card because coverage varies by plan and state.

Updated: November 14, 2025

Reviewed by: Dr. Donald L. Aivalotis, II

This guide explains whether Health Care Service Corporation (HCSC) covers massage therapy, including medical necessity rules, coverage limitations, provider requirements, and pre-authorization criteria.

Note: HCSC is the parent company behind Blue Cross and Blue Shield plans in Illinois, Texas, Oklahoma, New Mexico, and Montana. Coverage for massage therapy is administered through those plan contracts, not under an “HCSC” consumer brand.

Is Massage Therapy Covered by HCSC Plans?

Sometimes — but usually only when massage therapy is provided as a medically necessary physical medicine or physical therapy service, not as a stand-alone spa or wellness massage.

Across HCSC’s Blue Cross and Blue Shield plans (BCBS Illinois, Texas, Oklahoma, New Mexico, and Montana), massage-related services are generally handled under physical medicine and rehabilitation rather than as a separate “massage” benefit. Massage is typically billed using CPT 97124 (massage therapy) or addressed within manual/physical medicine codes, and must meet medical-necessity criteria within a documented treatment plan.

HCSC’s clinical payment policy for physical medicine and rehabilitation services requires that therapy (including manual and massage-type procedures) be skilled, not maintenance, tied to a specific diagnosis, and expected to produce measurable functional improvement over a predictable period of time.¹ Massage for general relaxation, stress relief, or “wellness” is not considered medically necessary.

In several HCSC-administered plans, massage therapy under CPT 97124 is managed through utilization review vendors (such as eviCore) and appears on prior authorization lists, meaning the service must be reviewed and approved to be covered.²

Some HCSC benefit booklets explicitly list “massage therapy” as a non-covered service except when it qualifies under the member’s physical therapy or rehabilitation benefit, reinforcing that stand-alone massage is usually excluded as a medical benefit.³

Because HCSC administers many different plan designs for employers, individuals, and government programs, the exact rules for massage therapy can vary by state and by product. You must always verify the member’s specific benefit plan.

HCSC Plan Limitations on Massage Therapy

Key limitations that appear repeatedly across HCSC policies and benefit documents include:

Massage is considered part of physical medicine or physical therapy, not a cosmetic or spa service.
Therapy must be skilled and provided by a qualified health professional under an approved treatment plan, with documentation linking diagnosis to service and showing expected functional improvement.¹
Services that are maintenance in nature (ongoing treatment once a condition has plateaued) are not medically necessary and are not covered.¹
Some HCSC HMO/PPO contracts list “massage therapy” in the section of services that are not covered, except when performed as part of covered therapy benefits.³
Visit limits for physical therapy/rehabilitation (per year or per condition) may indirectly cap how many massage-including sessions can be covered.

HCSC’s physical medicine policy also cautions that certain therapy codes (for example, manual therapy CPT 97140) must not be used interchangeably with massage codes (97124), underscoring that billing must accurately reflect the service performed and that massage is tightly defined within therapy benefits.¹

When Is Massage Therapy Covered by HCSC Plans?

Massage therapy may be covered under HCSC-administered plans when all of the following apply:

The massage is part of a physical medicine or physical therapy treatment plan (not a separately purchased massage session).
It is billed under an appropriate covered therapy code (for example, CPT 97124 (massage therapy) or related manual therapy codes) by an eligible provider.
There is documentation of medical necessity, including a specific diagnosis, impairment, and functional goals, as described in HCSC’s PT/OT medical policy.⁴
The treatment is expected to result in measurable functional improvement within a reasonable time frame, not simply provide temporary symptomatic relief.^1,4

Clinical situations where massage might be incorporated as part of a covered therapy plan can include:

Acute musculoskeletal injuries (sprains, strains) being treated with physical therapy.
Post-surgical rehabilitation where soft-tissue work supports recovery and function.
Certain chronic conditions when a short, goal-directed course of skilled therapy is documented as medically necessary.

Exact coverage can differ by state plan (Illinois vs. Texas vs. Oklahoma, etc.) and by employer group, so providers should confirm benefits and PA rules for each member.

Does Massage Therapy Require Pre-Authorization?

Often yes, especially when billed under CPT 97124 or as part of a longer physical therapy course.

HCSC utilization-management documents and procedure code lists show CPT 97124 (massage therapy) flagged for management by external review vendors (such as eviCore) in some Medicaid and commercial products, meaning prior authorization or clinical review is required before services are covered.²

In practice, this usually means the provider must submit:

Diagnosis code(s) and clinical history
A physical therapy or rehabilitation evaluation
A written plan of care with functional goals
Planned frequency and duration of therapy
Periodic progress notes for continued authorization

Because pre-authorization rules vary across HCSC lines of business (commercial, Medicaid, Medicare Advantage), the safest approach is to verify requirements using the appropriate BCBS plan’s medical policy portal and pre-certification tools.

Massage Therapy That Is Not Covered

HCSC-administered plans commonly do not cover massage therapy when it is:

Provided by an independent massage therapist, spa, or wellness center outside of a covered therapy setting.
Performed for general wellness, stress relief, or relaxation without a qualifying medical diagnosis.
Considered maintenance care after the member has reached maximum medical improvement.¹
Listed as an excluded service in the plan’s “what’s not covered” section (e.g., some HMO contracts group “hypnotism, massage therapy and aroma therapy” as non-covered services).³
Billed with non-covered or experimental alternative-therapy techniques that fall under “non-covered physical therapy services.”⁵

Members may still choose to pay out-of-pocket for wellness massage, but those services generally will not reimburse through HCSC-administered health plans.

How to Get Pre-Authorization for Massage Therapy

If you believe massage therapy may be covered under a member’s HCSC-administered plan, a typical workflow is:

Confirm the member’s physical therapy/rehabilitation benefits and any visit limits.
Perform and document a formal PT or rehab evaluation with diagnosis and functional deficits.
Develop a written plan of care indicating when and how massage/manual therapy will be used.
Submit the necessary prior authorization/pre-certification request (often through eviCore or the plan’s UM portal) before initiating treatment, if required.²
Update progress notes and outcome measures regularly to support ongoing medical necessity.

For members, the most direct route is to call the customer service number on their Blue Cross and Blue Shield ID card or log into their plan’s member portal to see what PT/manual therapy services are covered and whether pre-authorization is required.

Does HCSC Require a Referral for Massage Therapy?

Referral requirements depend on the specific HCSC-administered plan:

HMO plans under BCBS IL/TX/OK/NM/MT often require a primary care provider (PCP) referral for physical therapy services, which would include any massage delivered as part of PT.
PPO plans may allow members to see in-network physical therapists without a referral, though prior authorization and visit caps can still apply.
Medicaid and Medicare Advantage products may have their own referral and PA rules defined by contract and state/federal regulations.

Because HCSC administers many different plan types, referral requirements should always be confirmed in the member’s benefit booklet or online account.

Documentation Requirements

HCSC’s clinical payment and coding policies emphasize that physical medicine and rehabilitation services must be well documented to be eligible for reimbursement.^1,4

Initial evaluation with diagnosis and objective findings
A written plan of care describing goals, frequency, and duration
Identification of the specific service performed (e.g., massage vs. manual therapy vs. therapeutic exercise)
Start/stop times for time-based codes
Progress notes showing measurable functional improvement over time

Using the correct CPT code (for example, not substituting a manual therapy code for massage or vice versa) and maintaining clear records are essential to avoid denials.

Reimbursement for Out-of-Network Massage Therapy

For PPO members, some HCSC plans may reimburse out-of-network physical therapy services, but this typically applies to therapy delivered by licensed PTs/OTs or other covered providers—not stand-alone visits to independent massage therapists.

Members and providers should check:

Whether the plan includes out-of-network PT benefits.
Whether massage is billed as part of covered physical therapy (e.g., CPT 97124) versus billed as a separate massage service.
Out-of-network deductibles, coinsurance, and visit limits.

In many cases, wellness massage is not reimbursable even when an out-of-network benefit exists.

Where to Find More Information

HCSC publishes medical and clinical payment policies for its Blue Cross and Blue Shield plans. Useful starting points include:

BCBS state medical policy portals for physical therapy and rehabilitation services (e.g., BCBS Illinois Medical Policies).
The physical medicine and rehabilitation clinical payment policy and the Physical Therapy (PT) and Occupational Therapy (OT) Services medical policy.
Plan-specific benefit booklets and “What’s Not Covered” sections for exclusions like massage therapy.

Members should log into their Blue Cross and Blue Shield plan account or call the customer service number on their ID cards for plan-specific answers about massage therapy coverage.

Frequently Asked Questions

Does HCSC cover massage therapy at a spa or massage clinic?
No. HCSC-administered plans generally do not cover spa or wellness massage. Coverage, when available, is tied to physical medicine or physical therapy services billed by eligible providers.

Is massage covered if it is part of physical therapy?
Possibly. Massage billed under CPT 97124 or similar codes as part of a medically necessary PT or rehabilitation plan may be covered when it meets HCSC’s medical-necessity criteria and plan limits.

Why does prior authorization matter for massage therapy?
In many products, massage therapy codes are managed by utilization review vendors, meaning visits must be authorized to confirm medical necessity and benefit eligibility before they are covered.

How can I find out if my specific plan covers massage therapy?
Members should check their benefit booklet, log into their BCBS plan account, or contact customer service. HCSC’s community FAQ pages repeatedly direct members to have coverage checked individually, because benefits vary by plan.

References

Health Care Service Corporation. CPCP040 – Physical Medicine and Rehabilitation Services. Clinical payment and coding policy outlining documentation and medical-necessity requirements for physical medicine services, including manual therapy and related codes.
Blue Cross and Blue Shield of Illinois. Prior Authorization Procedure Code List showing CPT 97124 (massage therapy) as a managed service under eviCore for certain products.
Blue Cross and Blue Shield of Texas, a Division of HCSC. Blue Advantage HMO – Schedule of Copayments and Benefit Limits, “What’s Not Covered” section (listing massage therapy among non-covered services except under therapy benefits).
HCSC/BCBS State Plans. Physical Therapy (PT) and Occupational Therapy (OT) Services – Medical Policy THE803.010, describing coverage for skilled PT/OT services and functional improvement requirements.
HCSC. Non-Covered Physical Therapy Services – Medical Policy THE803.008 and related communications regarding alternative and non-covered therapy modalities.