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Using Your Health Savings Account (HSA) for Massage Therapy

Many people utilize a health savings account (HSA), or flexible savings account (FSA), to defer funds tax-free from their salaries.  These monies can be used during the year to pay for a large variety of medical expenses.  Everything from deductibles and co-payments to transportation to essential healthcare providers.  One caveat: you have to use these funds before the end of the year or you will lose them!   (NOTE:  this applies to FSA’s, not most HSA’s.  Be sure to check with your plan administrators for clarification of this rule.)

Spending the funds in your HSA for massage therapy can be tricky, but it is possible.  To be considered a qualified medical expense, the IRS regulations state that medical care expenses MUST be primarily to alleviate or prevent a physical or mental ailment.  In IRS Publication 502 “Therapy” is included as defined for therapy received as medical treatment.  Examples of illnesses that could qualify include post-surgical pain, migraines, carpal tunnel syndrome, stress, back pain, arthritis, diabetes, hypertension, fibromyalgia, chronic fatigue, anxiety, MS, depression and pain management.

The IRS ruling states: “Medical expenses are the costs of diagnosis, cure, mitigation, treatment, or prevention of disease, and the costs for treatments affecting any part or function of the body. These expenses include payments for legal medical services rendered by physicians, surgeons, dentists, and other medical practitioners. They include the costs of equipment, supplies, and diagnostic devices needed for these purposes. Medical care expenses must be primarily to alleviate or prevent a physical or mental defect or illness. They do not include expenses that are merely beneficial to general health, such as vitamins or a vacation.”

How to get Health Savings Account (HSA) approval for massage therapy.

Set up an appointment with your medical doctor and let them know that you have HSA funds that you would like to use for massage therapy for treatment/prevention of your condition. If your physician agrees, they will need to provide three pieces of information on the prescription:

1. Medical necessity: why you need massage therapy (example: to relieve back pain)

2. Frequency: number of sessions per month (example: minimum of two sessions per month)

3. Duration: length of treatment (example: 3,6,9,12 months)


It’s also a good idea to be certain that you are getting the correct prescriptions/documentation in order to use your HSA funds so check with your employer. The appropriate department is usually human resources since they administer benefits for employees. If they can’t answer your question, then they should be able to direct you to the administrator of your HSA plan. It’s always best to be sure that you know that massage (with prescription) would be covered before you make your appointment so that you are not responsible for paying out of pocket or taking a tax hit.

Your doctor or health practitioner can send the referral to me via email.  It is also a good idea to have a copy for your own records.  Once you have the prescription then you can set up an appointment for massage. Keep the prescription in a safe place in case you need to provide documentation. Bring your HSA card with you to your appointment.

More information about HSA is made available within IRS publication 969 & 502

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