Can you use a HSA for massages?

Health Savings Accounts (HSAs) provide a tax-advantaged way to save for medical expenses. As more people recognize the therapeutic benefits of massage therapy, many ask: "Can you use HSA for massage?" This comprehensive guide explains when massages are HSA eligible and the requirements you need to meet in 2025.

Can you use HSA for massage? The basic rules

The straightforward answer: It depends on the purpose of the massage.

According to IRS guidelines, massage therapy is not automatically considered a qualified medical expense. For a better understanding of what expenses are typically HSA-eligible, check out our guide on what is an HSA. However, there are specific circumstances when you can use your HSA for massage therapy:

• Medically necessary massages: You can use HSA funds if a licensed physician has prescribed massage therapy to treat a specific medical condition
• General wellness massages: You cannot use HSA funds for massages intended for general relaxation or wellness

This distinction is crucial for determining whether your massage therapy qualifies as an HSA-eligible expense.

When are massages HSA eligible?

For a massage to be HSA eligible, it must meet specific criteria:

Medical necessity requirement

The massage must be prescribed by a licensed physician or healthcare provider to treat, cure, mitigate, or prevent a specific medical condition. According to the American Massage Therapy Association (AMTA), some medical conditions where massage therapy might be prescribed include:

• Chronic pain disorders: Such as fibromyalgia or chronic back pain
• Muscle injuries: Including sprains, strains, or sports injuries
• Post-surgical rehabilitation: To help with recovery after certain procedures
• Temporomandibular joint disorders (TMJ): To relieve associated facial and neck tension
• Certain neurological conditions: Including some types of headaches and neuropathy
• Lymphedema: To help with lymphatic drainage
• Musculoskeletal disorders: Such as sciatica or carpal tunnel syndrome

Required documentation

To use your HSA for massage therapy, you need proper documentation:

1. Letter of Medical Necessity (LMN) from your healthcare provider that includes:
   • Your specific diagnosis (medical condition)
   • Why massage therapy is medically necessary for treatment
   • Recommended frequency and duration of treatment
   • Statement that the massage is not for general wellness
2. Detailed receipts from your massage therapist showing:
   • Date of service
   • Type of massage provided
   • Cost of treatment
   • Provider's information and credentials

Keep these records for at least 7 years in case of an IRS audit. Without proper documentation, your massage expenses may not qualify for HSA reimbursement, even if they were for medical reasons.

Can I use HSA for massage without a prescription?

Generally, no. Without a prescription or Letter of Medical Necessity from a healthcare provider, massages are not considered qualified medical expenses for HSA purposes. This is true even if you personally experience medical benefits from the massage.

There are no exceptions to this rule. Even if you're experiencing pain or muscle tension, a self-prescribed massage would not qualify for HSA reimbursement. The IRS requires that the treatment be formally prescribed by a medical professional.

Types of massage therapy and their HSA eligibility

Different types of massage therapy may qualify for HSA reimbursement when medically prescribed:

Potentially HSA-eligible massage types (with prescription)

• Therapeutic massage: Focused on treating specific medical conditions or injuries
• Deep tissue massage: To address chronic muscle tension or injuries
• Medical massage: Specifically directed at diagnosed medical issues
• Manual lymphatic drainage: For conditions like lymphedema
• Neuromuscular therapy: For treating trigger points and nerve compression
• Myofascial release: For fascial restrictions and pain

Non-HSA-eligible massage types (even with prescription)

• Relaxation massages: Purely for stress relief or general wellness
• Spa treatments: Including hot stone or aromatherapy massages for relaxation
• Couples massages: Generally considered recreational rather than medical
• Chair massages: Quick sessions typically aimed at general wellness

It's worth noting that the type of massage matters less than the medical necessity and documentation. A Swedish massage could be HSA-eligible if prescribed for a specific medical condition, while a deep tissue massage would not be eligible if it's just for general wellness.

Finding HSA-eligible massage providers

When seeking massage therapy that qualifies for HSA reimbursement, look for:

Qualified providers

• Licensed massage therapists (LMTs): Ensure they're properly certified in your state
• Physical therapy practices: Often employ massage therapists as part of rehabilitation
• Chiropractic offices: Many offer massage therapy as complementary treatment
• Medical spas: Some provide medically necessary massage therapy (not just relaxation)

Questions to ask potential providers

1. "Do you accept HSA cards for medically necessary massage?"
2. "Can you provide detailed receipts with treatment codes?"
3. "Do you work with patients who have Letters of Medical Necessity?"
4. "What information do you include on your receipts and invoices?"

Some providers are more familiar with HSA requirements and can help ensure your documentation meets IRS standards.

Benefits of using HSA for massage therapy

When your massage therapy qualifies as a medical expense, using your HSA offers several advantages:

Tax advantages

• Pre-tax contributions: Money contributed to your HSA isn't subject to federal income tax
• Tax-free growth: Any interest or investment gains in your HSA accumulate tax-free
• Tax-free withdrawals: When used for qualified medical expenses, withdrawals aren't taxed

Financial benefits

• Budget for ongoing treatment: Use pre-tax dollars for potentially costly massage therapy
• Manage chronic conditions: Fund regular treatments for ongoing medical issues
• Integrate with other care: Complement other HSA-eligible treatments with massage therapy

Risks of using HSA for non-qualifying massages

Using your HSA for massages that don't qualify as medical necessities comes with significant risks:

Tax consequences

If you use HSA funds for massages that don't qualify as medical expenses:

• You'll pay income tax on the amount spent
• You'll face an additional 20% penalty if you're under 65
• You may trigger an IRS audit of your HSA expenses

Documentation scrutiny

The IRS may request documentation proving your massage was medically necessary. Without proper documentation, you risk:

• Having to pay back taxes
• Additional penalties
• Potential disqualification from future HSA participation

HSA vs. FSA for massage therapy

Here's how Health Savings Accounts (HSAs) compare to Flexible Spending Accounts (FSAs) when it comes to covering massage therapy.

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Both accounts require similar documentation for massage therapy to qualify as an eligible medical expense.

Benefits of HSA-eligible massage therapy

When your massage therapy qualifies as an HSA-eligible expense, you gain several advantages:

Tax benefits

• Pre-tax contributions: Money contributed to your HSA isn't subject to federal income tax
• Tax-free growth: Any interest or investment gains in your HSA grow tax-free
• Tax-free withdrawals: When used for qualified medical expenses, withdrawals aren't taxed

For 2025 contribution limits and other important details, check our guide to 2025 HSA contribution limits.

Healthcare advantages

• Access to effective treatment: Massage therapy can provide relief for many conditions
• Integrated healthcare approach: Combines well with other treatments
• Reduced out-of-pocket costs: Makes massage therapy more affordable when medically necessary

Risks of using HSA for non-qualifying massage

Using your HSA for massage therapy that doesn't qualify carries significant risks:

Potential tax consequences

If you use HSA funds for non-qualifying massage therapy:

• You'll owe income tax on the amount spent
• You'll face an additional 20% penalty tax (if under age 65)
• Your HSA administrator may flag your account for potential misuse

Documentation scrutiny

If audited by the IRS, you'll need to prove your massage therapy was medically necessary. Without proper documentation, you risk:

• Having to pay back taxes
• Additional penalties
• Potential complications with future HSA use

How to approach your healthcare provider about HSA-eligible massage

If you believe massage therapy would help treat a medical condition:

1. Schedule a consultation with your healthcare provider
2. Discuss your symptoms and how massage might help
3. Ask specifically if massage therapy is appropriate for your condition
4. Request documentation if they recommend massage therapy
5. Obtain a detailed Letter of Medical Necessity that includes:
   • Your specific diagnosis
   • Why massage is necessary for treatment
   • Recommended frequency and duration

Finding HSA-eligible massage providers

Not all massage therapists will provide the documentation needed for HSA reimbursement. Look for:

• Licensed massage therapists with medical or clinical experience
• Massage therapists who work with healthcare providers
• Providers familiar with HSA documentation requirements
• Therapists who offer detailed receipts

Ask potential providers if they have experience working with clients using HSA funds and if they can provide the necessary documentation.