Updated: November 14, 2025
Reviewed by: Dr. Donald L. Aivalotis, II
This guide explains whether Metropolitan Group covers massage therapy, including medical necessity rules, coverage limitations, provider requirements, and pre-authorization criteria.
Is Massage Therapy Covered by Metropolitan Group?
Coverage varies — Metropolitan Group does not publish a single, system-wide policy for massage therapy. Benefits are determined by the specific employer’s plan design.
Metropolitan Group administers health plans for employer groups, and each employer chooses its own covered and excluded services. Unlike major national insurers that maintain public clinical policy manuals, Metropolitan Group does not release standardized medical policies for massage therapy. As a result, massage therapy may be:
- Excluded entirely under some employer plans
- Covered only when part of physical therapy (such as CPT 97124 delivered by a licensed physical therapist)
- Covered conditionally, only with a physician referral and medical-necessity review
- Not covered when performed by a massage therapist in a spa, clinic, or wellness setting
Members must review their employer’s Summary of Benefits and Coverage (SBC) or request a copy of the full plan certificate to confirm whether massage therapy is included or excluded.
Metropolitan Group’s Limitations on Massage Therapy
Because coverage is employer-specific, the following limitations commonly appear across plans administered by similar employer-group carriers:
- Massage therapy is often not covered as a stand-alone benefit.
- Massage performed by a massage therapist (LMT) is usually excluded.
- Massage for relaxation, stress reduction, or wellness is not considered medically necessary.
- Massage may only be payable when performed by a physical therapist or other eligible provider as part of a covered rehabilitation plan.
- Pre-authorization may be required if massage is part of physical therapy.
These limitations are consistent with common employer-sponsored plan structures across the industry and should be verified directly with the member’s plan.
When Is Massage Therapy Covered?
Massage therapy may be covered under a Metropolitan Group plan when:
- It is included within an active physical therapy treatment plan.
- It is performed by a credentialed provider such as a PT, OT, or chiropractor.
- The service is billed under therapy codes (for example, CPT 97124) rather than stand-alone massage codes.
- The member has a qualifying diagnosis and the therapist documents measurable improvement.
Plans that cover massage almost always classify it as a therapy modality rather than a wellness service.
Does Massage Therapy Require Pre-Authorization?
Often yes — especially when massage is included as part of physical therapy.
Employer plans administered by Metropolitan Group commonly require pre-authorization for physical therapy, occupational therapy, chiropractic care, or extended therapy sessions. If massage falls under these benefits, the associated pre-authorization rules apply.
- Diagnosis code(s)
- Plan of care with goals
- Medical necessity documentation
- Expected functional improvement timeline
Failure to obtain pre-authorization (when required) may result in denial of coverage.
Massage Therapy That Is Not Covered
Most Metropolitan Group employer plans exclude:
- Stand-alone massage therapy
- Massage performed by an LMT without therapy integration
- Spa or relaxation massage
- Massage for stress, tension, or wellness
- Ongoing maintenance massage without measurable functional goals
Members who want wellness or stress-relief massage should expect to pay out-of-pocket.
How to Verify Massage Therapy Coverage
Because Metropolitan Group plans vary by employer, members should:
- Review the plan’s SBC under “Rehabilitative and Habilitative Services.”
- Request the full Certificate of Coverage from HR or the plan administrator.
- Ask whether massage is listed as a covered therapy modality when performed by PT/OT/DC.
- Confirm any pre-authorization or referral requirements.
- Call Member Services using the number on your ID card and ask specifically:
“Is massage therapy covered under my plan, and who can perform it?”
Providers can also confirm benefits through the plan’s provider portal or benefits-verification system.
Does Metropolitan Group Require a Referral?
Referral requirements depend entirely on the employer’s plan. HMO-style plans often require PCP referrals for therapy, while PPO-style plans may not.
- HMO plans: Referral often required for PT/OT/chiropractic.
- PPO plans: Direct access to therapy may be allowed.
- Hybrid plans: Referral may be required only after a set number of visits.
Check your member booklet or call Member Services to determine whether your plan requires referrals.
Documentation Requirements
If massage therapy is considered under therapy benefits, providers must document:
- Initial evaluation and diagnosis
- Functional impairments
- Goals, frequency, and duration of treatment
- Progress notes showing measurable improvement
- Accurate coding for any soft-tissue or massage-related services
Documentation must show that the service contributes to functional restoration, not comfort or maintenance.
Reimbursement for Out-of-Network Massage Therapy
If a plan includes out-of-network coverage, reimbursement depends on:
- Whether massage is a covered therapy modality
- Whether the provider is eligible (PT/OT/DC vs. LMT)
- Whether documentation meets therapy standards
Out-of-network benefits do not override exclusions. If massage is excluded in your plan, it will not be reimbursed even if your plan offers out-of-network coverage for other services.
Where to Find More Information
Because Metropolitan Group does not publish central public medical policies, the most reliable sources for coverage are:
- Your employer’s Summary of Benefits and Coverage (SBC)
- The full Certificate of Coverage or Summary Plan Description (SPD)
- Your HR/Benefits department
- Member Services (phone number on your ID card)
Ask specifically whether your plan covers massage therapy as part of rehabilitative care.
Frequently Asked Questions
Does Metropolitan Group cover massage therapy?
Some employer plans may cover massage only when delivered by a PT, OT, or chiropractor as part of an active therapy plan. Many plans exclude stand-alone massage entirely.
Can a massage therapist bill Metropolitan Group?
Usually no. Coverage is typically limited to therapy services performed by credentialed PT/OT/DC providers.
If my employer plan excludes massage, can I appeal?
You may appeal a denial, but exclusions in the plan document generally cannot be overridden.
How do I find out what my specific plan covers?
Review your SBC, request your Certificate of Coverage from HR, or call Member Services.
References
Because Metropolitan Group does not publish centralized public medical policies, members must refer to their employer’s SBC, Certificate of Coverage, or Summary Plan Description (SPD). Statements in this article are based on common employer-group plan structures and industry-standard benefit models.