Does HSA or FSA Cover Massage Therapy?
- James Tremblay
- 3 days ago
- 3 min read
Short answer: sometimes. Massage therapy can be paid for with HSA or FSA funds when it is medically necessary, but not when it is purely for general wellness or relaxation. That distinction is what causes most of the confusion.
I’m a Licensed Massage Therapist (LMT) and Certified Rolfer®, and this is one of the most common questions I hear from clients. Below is a clear, practical explanation of when HSA or FSA funds can be used for massage therapy, when they usually can’t, and how to document things correctly.
How HSA and FSA Rules Actually Work
Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) are governed by IRS rules. Coverage decisions are not made by your massage therapist, your HSA bank, or your insurance company.
What matters is whether the expense qualifies as a medical expense under IRS guidelines.
In simple terms: HSAs and FSAs can be used for expenses related to the diagnosis, treatment, mitigation, or prevention of disease. General health, wellness, or relaxation expenses do not qualify.
Massage therapy sits in the middle, because it can be either medical or wellness depending on why it is being used.
When Massage Therapy Is HSA or FSA Eligible
Massage therapy is generally eligible when it is used to treat a specific medical condition.
Common examples include:
Chronic neck, back, or shoulder pain
Sciatica or nerve irritation
Headaches or migraines
Post-injury or post-surgical recovery
Repetitive strain injuries
Muscle tension contributing to pain or restricted movement
In these cases, massage therapy is considered therapeutic, not recreational.
Documentation that helps
To make reimbursement as defensible as possible, it helps to have:
A diagnosis from a licensed healthcare provider (MD, DO, NP, PA, PT, etc.)
A written referral or prescription recommending massage therapy
A receipt or invoice from the massage therapist that includes:
Provider name
License number
Date of service
Amount paid
Description such as “therapeutic massage” or “medical massage”
If you have a session with me, I can provide you with such a receipt, which is often termed a "superbill". With these pieces in place, HSA or FSA use is typically straightforward.
When Massage Therapy Is Not HSA or FSA Eligible
Massage therapy is usually not eligible when it is classified as general wellness.
Examples that typically do not qualify:
Relaxation or stress-relief massage without a medical complaint
Spa or resort massage
Massage for general fitness or recovery without a diagnosis
Gift certificates purchased in advance
Even though these sessions may feel beneficial, the IRS considers them personal expenses.
Paying Without a Prescription
In real-world practice, some people:
Pay for massage with an HSA debit card
Reimburse themselves later
Do not submit a prescription upfront
This sometimes works, but it places responsibility on the account holder, not the massage therapist. If the IRS ever asks, the key question is, "Was the massage therapy primarily for treatment of a medical condition, or for general wellness?" Having a diagnosis or referral makes that much easier to answer.
HSA vs FSA: Important Differences
Although they sound similar, HSAs and FSAs are not the same.
HSAs:
Are individually owned
Do not require pre-approval
Are reviewed only if audited
Allow reimbursement at any time after the expense occurs
FSAs:
Are employer-sponsored
Often require documentation before reimbursement
Have rules that vary by employer plan
Because of this, massage therapy is more commonly reimbursed through HSAs than FSAs.
Practical Takeaways
Massage therapy can be HSA or FSA eligible
Medical necessity is the deciding factor
Documentation protects you
General wellness massage usually does not qualify
If you are unsure whether your sessions qualify, a brief conversation with your healthcare provider or HSA/FSA administrator can provide clarity.
Reputable Sources and Further Reading
If you want to review the official guidance these rules are based on, the following sources are helpful and authoritative:
IRS Publication 502 – Medical and Dental Expenses: Explains what qualifies as a medical expense for HSAs and FSAs, including services that require medical necessity.
IRS – Health Savings Accounts (HSAs): Overview of HSA eligibility, contributions, and qualified medical expenses.
Healthcare.gov – HSA and FSA Basics: Plain-language explanations of how HSAs and FSAs work and what they can be used for.
These are the same sources HSA and FSA administrators rely on when evaluating reimbursement questions.
James Tremblay is a Certified Rolfer® and Licensed Massage Therapist based in Farmington, Michigan, serving Novi, West Bloomfield, Southfield, Livonia, and beyond.