How to Use Your FSA, HRA, or HSA for Massage Therapy

Did you know that your Health Savings Account (HSA), Flexible Spending Account (FSA), or Health Reimbursement Arrangement (HRA) might cover massage, bodywork, or energy therapy services? Many people aren’t aware these funds can go beyond traditional medical expenses to include therapies that address chronic pain, stress, or other health conditions. If your healthcare provider deems these treatments medically necessary, you could use pre-tax dollars to invest in your health and well-being. Here’s what you need to know to take advantage of this benefit.

Can HSA, FSA, or HRA funds cover massage and similar therapies?

Yes! These accounts can often be used to pay for services like massage therapy, energy work, or other bodywork therapies if they’re deemed medically necessary. For example, if a healthcare provider prescribes massage therapy to address chronic pain, reduce stress, or support recovery from an injury, the IRS allows the expense to be covered under your HSA, FSA, or HRA.

The key is having documentation to show the medical necessity of the treatment. This is where a Letter of Medical Necessity (LMN) comes in.

What is a Letter of Medical Necessity (LMN)?

A Letter of Medical Necessity (LMN) is a document provided by your healthcare provider that explains why a specific therapy or service is essential to treat or manage a medical condition. It acts as proof for your HSA, FSA, or HRA administrator that the expense qualifies under IRS guidelines.

An LMN typically includes:

Patient information: Your name and relevant details.
Medical condition: A diagnosis or description of the condition being treated.
Recommended treatment: An explanation of why massage, bodywork, or energy therapy is necessary.
Duration of treatment: How long the therapy is expected to be needed.

This document ensures your therapy aligns with the guidelines for eligible expenses, making it easier to have your claims approved.

How to request a Letter of Medical Necessity

If you believe massage, bodywork, or energy therapy could improve your health, here’s how to get started:

Talk to your healthcare provider
Schedule a visit with your doctor, chiropractor, or another licensed healthcare provider. Share your symptoms or concerns and discuss how therapeutic treatments could support (or have been supporting) your condition.
Request the LMN
If your provider agrees the therapy is necessary, ask them to draft an LMN. Ensure it includes all the required details, such as your condition, the recommended treatment, and its expected duration. Your healthcare provider likely has a template for such requests and is familiar with the process, however some administrators may have their own LMN templates or additional guidelines, so double-check their requirements.
Submit the LMN
Send the LMN to your HSA, FSA, or HRA administrator along with any required forms or documentation.
Keep copies of your records
Hold onto the LMN and any receipts for your sessions. These may be required for reimbursement or tax purposes.

Wait! What is an Administrator?

An “administrator” in the context of HSA, FSA, or HRA accounts, is the organization or company responsible for managing your pre-tax health account. The administrator ensures that the account complies with IRS regulations, processes claims, reimburses eligible expenses, and provides customer support for account holders. Here’s a breakdown of the different types of administrators:

Third-party administrators (TPAs): Independent companies that manage employer-sponsored FSAs or HRAs. Examples include companies like PayFlex, WEX, and HealthEquity.
Financial institutions: For HSAs, your administrator is often a bank or credit union that provides the HSA account, like Optum Bank or Fidelity.
Employer-sponsored administrators: Some employers manage HRA accounts in-house or through a designated provider.

If you want to use your HSA, FSA, or HRA for massage or energy therapy, the administrator is the person you’ll communicate with to ensure the expenses are approved. Submitting the Letter of Medical Necessity and understanding specific requirements for eligibility typically involves working directly with the administrator. It’s always a good idea to check their guidelines, as requirements and processes can vary slightly between administrators.

If you’re still not sure who your administrator is, check with your HR department, or call the number on the back of your HRA, FSA, or HSA card for further guidance.

Additional tips for using your HSA for massage therapy

To make the most of your HSA, FSA, or HRA funds, keep the following in mind:

Understand your plan’s rules: Each plan is unique, so check with your administrator to confirm what they cover and any specific documentation they require.
Act before FSA funds expire: FSA funds typically have a “use it or lose it” rule, meaning unused funds may expire at the end of the plan year. Schedule and pre-pay for your therapy sessions before your balance disappears. Not sure when you’ll be able to get in for a session? Consider purchasing a pre-paid block of sessions to schedule as needed.
Verify eligible expenses: If you’re unsure whether a particular therapy is covered, review IRS Publication 502 or ask your plan administrator directly.

Why consider massage, bodywork, or energy therapy?

Massage therapy, bodywork, and energy healing therapies aren’t just luxuries—they can be integral to managing physical and mental health. Whether you’re dealing with chronic pain, stress, or a specific medical condition, these therapies can provide meaningful support. If you’ve been hesitating to explore massage, bodywork, or energy therapy because of cost concerns, using your FSA, HRA, or HSA for massage therapy could be the solution. Talk to your healthcare provider about whether these treatments might benefit you, and get started with an LMN to take advantage of your pre-tax savings.

Additional references for your convenience: