A Health Savings Account (HSA) is a tax-advantaged financial tool paired with a high-deductible health plan, allowing funds to be set aside for qualified medical expenses. The Internal Revenue Service (IRS) governs these accounts and requires any expense to be for the diagnosis, cure, mitigation, treatment, or prevention of a specific disease or illness. Massage therapy can qualify for HSA funds, but only when strict conditions of medical necessity are met. Without a clear medical purpose, the expense is not eligible for reimbursement.
General Eligibility Rules for Massage Therapy
The determining factor for using HSA funds is whether the service treats a specific medical condition, as outlined in the Internal Revenue Code Section 213(d). Massage therapy is considered a “dual-purpose” expense, meaning it is not automatically covered like a doctor’s visit. Services intended merely for stress relief, relaxation, general wellness, or personal enjoyment cannot be paid for with HSA dollars.
The IRS requires the expense to primarily alleviate or prevent a physical or mental disability or illness. This means a massage must be prescribed to treat a diagnosed injury or disease, such as chronic back pain, fibromyalgia, or post-surgical rehabilitation. The key distinction is the presence of a specific, identifiable medical condition that the massage is intended to treat.
For instance, a massage to ease muscle tension after work does not qualify because it is for general wellness. Conversely, a massage integrated into a physical therapy plan to restore function after a severe muscle strain or address chronic pain may be eligible. A licensed medical practitioner must document the necessity and confirm the treatment is not simply for general health benefits.
Obtaining a Letter of Medical Necessity
To demonstrate that massage therapy meets the strict requirement for treating a specific condition, the account holder must obtain a Letter of Medical Necessity (LMN). This letter serves as the official documentation that links the service to a qualified medical expense and must be secured before the massage sessions are paid for with HSA funds. The LMN transforms a dual-purpose expense into a fully qualified expense.
The letter must contain specific pieces of information to be valid for HSA purposes:
- The patient’s specific diagnosis, providing the medical reason why the massage is required.
- The specific treatment plan, detailing the recommended frequency of sessions and the total duration considered medically necessary.
- The therapeutic goal, describing how the massage will mitigate, cure, or treat the diagnosed condition.
- The signature of a licensed medical practitioner, which can include a physician, doctor of osteopathy, physical therapist, or chiropractor.
If the treatment plan extends beyond the duration specified in the original LMN, a new letter must be obtained to cover the continuing sessions. This ongoing documentation ensures that the medical necessity is continuously justified as required by IRS regulations. The responsibility for securing this detailed documentation rests entirely with the HSA account holder.
Documentation and Audit Readiness
Using HSA funds for massage requires diligent record-keeping for potential future audits, as the burden of proof falls entirely on the account holder. Required documentation includes the original Letter of Medical Necessity and all detailed receipts from the massage therapist. Receipts must show the date, service description, and cost, correlating with the treatment frequency outlined in the LMN.
It is advisable to keep these records for at least seven years after the tax year of the withdrawal, as the IRS can audit returns for this length of time. If the IRS determines the expense was not qualified, the withdrawn amount becomes subject to ordinary income tax. If the account holder is under 65, the ineligible amount also incurs an additional 20% penalty.