You will have to find out if you can bill auto insurance in your state.  From what I understand, in most places you can.  Find out from other massage therapists or if you get a client calling saying they were just in an accident, get their insurance information and call the insurance company.  Tell them you are a MT and you have been just referred a patient.  You will need to tell them the claim number and the persons name.   Tell them you are licensed as a massage therapist and have a prescription for massage (yes you need a prescription) and ask if they will cover massage.  Tell them what CPT code you will be billing and some may need to know the diagnosis code that will come from the doctor.

The things to ask are how much will you be paid per unit of massage.  The CPT codes which indicate the procedure that was done is paid in 15 minute increments so an hour would be 4 units of massage.  The most common codes are 97124  and 97140.  Tell them you will be billing one of those codes and ask what they will pay.  Find out when you will get paid.  Some policies are Personal Injury Protection or MedPay.  Will they pay you before the case is settled.  Most will depending on the available benefits on their plans.  Most will have a certain amount that can be paid up front as the massages are done so you won’t have to wait years to be paid.  After benefits run out, you will have to wait to be paid.  You just have to decide if it is worth it and if you have enough cash flow to wait.

The other most common form of insurance is workers compensation or Labor and Industries as it is known in some states.  This is insurance for those who are hurt at work.  In most states you can bill for work related injuries but there are usually strict rules and limits.  You can usually find fees schedules on the workers comp. board websites.  Most will also have billing manuals or more help to learn how to bill insurance.  You have to find out what you will need to do in order to get paid.  You may have to sign up with them first and get a provider number.  You will need to know how many sessions you will be able to bill for.  There are some stated though that don’t really pay enough to make it worth your while but if you do need clients, even a low rate of pay is better than no income for that hour.

So you will need to decide if billing insurance is right for you.  Figure out your cost per client and if taking insurance will increase your profits.

You will then need to lean how to bill and how to do SOAP Charting. Hands Heal: Communication, Documentation, and Insurance Billing for Manual Therapists (LWW Massage Therapy and Bodywork Educational Series)  is a comprehensive manual for doing chart notes that will support your massage work.  It is important to show improvement in your sessions and document properly.

Insurance Billing 101 for Massage Therapists will also get you started in learning how to bill.

Related posts:

1. Billing Insurance Companies for Massage Therapists
2. Massage Insurance Billing Manual
3. Can a massage therapist bill insurance companies?

The massage school admissions people seem to forget the details though and most do not even know to ask about these kind of things and many of it won’t really matter to most – it is just part of ‘the job’.  People want to know if you can make a good living and things like that.  Just like any career, the answers depend really more on YOU and your abilities to put everything you learn in massage school together into something that creates a successful massage career.

So here goes:  things that they don’t tell you about when thinking about a career in massage

1. You will be doing a lot of laundry.  Each client requires a fresh set of very clean and sanitized sheets, face covers, bolster covers, pillow cases/covers.  5 clients a day – 5 days a week.
2. You will need to know how to fold a fitted sheet (if that is what you choose for your massage sheets- most do)
3. There are some really hairy guys out there that will challenge your use of oil/lotion and application methods in order to give an effective massage.
4. Yes, You will need to trim your nails really, really short or you will be scratching the client.  They will need to be filed smooth and kept that way.  Forget long nails, fake nails or fancy nail polish.
5. Yes, the big E (erection) happens. Men do weird things – ejaculate on tables, into towels, ask for happy endings, mess up your sheets and will challenge your boundaries.
6. You will get clients that have crushes on you, want to date you, want to give you expensive gifts. (Dating clients is illegal in many states and is against the code of ethics of most associations.)
7. No you don’t have to take math, but you have to take basic college level anatomy and physiology – science! You need math to do your bookkeeping, taxes and such.
8. Clients may come in sick, with runny noses, icky skin conditions, smelly feet, dirty hair and will come in right from the gym/workout sweaty from head to toe and expect you to touch them.
9. You will glide through massage school easily and graduate with honors and get a high paying ($45 an hour or more) right away – NOT.  Massage school often brings up peoples issues around touch and will often be a big growth process.  You will learn more about yourself.
10. You want to be a massage therapist because you want to help others.  They don’t tell you that helping others is the surest way to end up in burnout and that there are many deeper issues around helping others that are more about you than anything else.

What do you wish someone told you about becoming a MT?  What did they tell you in the admissions department or during school that you wished you had known about before deciding on a career in massage?

Related posts:

1. Become a massage therapist
2. Becoming a Massage Therapist
3. Why become a massage therapist?

The sites that are listed on the top of the first page of the search results many not always be the best choice.

Some of the things that I think you will need to know are the obvious things:

• Tuition.  The cost of massage school ranges anywhere from $5000 to $25,000.  Massage schools will make you call them to get the prices or make you contact them so then they have your contact info to keep calling/emailing you to get you into their massage school.  You have to figure out what massage school is really worth, how much training you will really need and balance that with what you can afford to pay.  Since entry level pay is about $15 an hour and you usually only work about 25 hours or less, you obviously will have trouble paying for school loans at a higher priced school.
• Who are the teachers?  Are they actually certified teachers?  Have they been teaching more than 10 years?  One of the things about teachers is that there was such an increase in massage schools over the last 10 years or so, that massage schools started hiring their last year graduates as massage school teachers.
• What licensing will you need to practice massage?  How many hours of training will it take in your state and what tests will you have to take to get your state massage license (if there is even a state license.)
• What is it really like to start your own massage business or find a job in massage?  Basically this is the time to really know yourself what it is like so you can compare it to what the schools are telling you.  Schools will try to make it sound more appealing just to get you into the classes.

Remember, Massage Schools are in the business of filling their massage schools with students.  You can read more in my Book - A Career in Massage -Is it for you?  available in paperback, Kindle and PDF and also find a list of Massage Schools.

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2. Massage Therapy Schools
3. Massage Schools

From what I have seen in my private massage practice, working with fibromyalgia is usually a combination of getting people to a Naturopath or nutritionist who can work with them on diet.  The results usually show that fibromyalgia is usually a combination of adrenal stress and inflammation.  It is also found in people under very stressful conditions such as losing a spouse or being in a very bad car accident.

If you are a massage therapist working with someone with fibromyalgia, it is important to start slowly and work gently with the patient/client until you can establish how much pressure you can use with out aggravating the condition.  Each person is very different.  I have had people who need really deep tissue work and some can only stand very light effleurage.

You can read more about massage for fibromyalgia on the main site.  There is a list of articles I have found online that talk about massage and fibromyalgia and also a list of good books.

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1. Sales process vs caring for massage therapists
2. The depth in deep tissue massage
3. Is the pressure ok?

How do you measure the amount of pressure or the massage technique that is done?  You can teach a 12 MT a specific technique and it will be done 12 different ways with each persons own unique touch and intention behind the technique. How do you regulate or measure the amount of pressure that is applied and how do you regulate or measure the exact spot in each muscle or muscle group so that you know exactly what it is that is making the difference?

There is also nothing really in massage that could replicate the idea of a placebo or sugar pill.  You can hand someone a pill that they don’t know what is in it, but how do you really do that with massage?

How do you control for all of the other factors in a persons life also – I guess that is a problem with all research – was it the intervention or the change in diet that they made or them getting more sleep or them living their life.

Yet one of the ways we will get the insurance companies and the general public’s attention is with having more research.  The insurance companies especially are moving toward using research to determine where they spend their money for their patients – what works best for the money spent.  It is also just as important to have research for the spa or relaxation division of the massage profession.  Spa massage, heat and special spa therapies are just as important in healing.

Getting massage therapists interested in research is another part of this challenge.  They are taught various techniques in school that are actually not proven scientifically and the research that is done to support various modalities is usually flawed in some way but massage therapists do not really know it because they are not trained in research literacy and more importantly – they see these same things work when they practice it.   When the ‘researchers’ show up and say something doesn’t work to the many massage therapists who are practicing that modality – it is like a slap in the face (even though the researchers that I have interacted with online don’t mean it that way- their approach is very well for lack of a better work -egotistical).   That is not going to get any points for research!  From what I understand so far in this process of learning about research is that it isn’t that it doesn’t work but more of the way that it is explained as to how it does work -(does that make any sense?)  For example – research does not support the practice of Reiki but there are many massage therapists, nurses and even people in hospitals and hospice units who practice it.  It does work but the reason it does work is a mystery really or so it is said to be by science.  Is it the therapeutic presence?  Most likely but we don’t really know.  Supposedly there is no such thing really (scientifically speaking) as Universal Energy according to this article- Reiki Can Not do Harm – or can it? by Christopher Moyer, a well known massage researcher and Assistant Professor of Psychology at University of Wisconsin-Stout

“universal energy” on which it is based cannot possibly exist, for if it did, it would have to do so in contradiction of the conservation of mass-energy principle, and that is as well supported by scientific evidence as practically any principle that we know

The problem with researching massage is how do we combine science with the art of massage and preserve the art of massage – of being present, of connecting, of being compassionate care givers, with science?  We (I) just want to do massage!

Related posts:

1. Evidence Based Massage
2. Massage Research Resources
3. Researching Massage Schools

Each state has different laws regarding the practice of massage and each has a different number of hours of education requirements.  The number of hours of training needed varies between 500-1000 hours of training and even within that requirement are variations in the number of hours of each specific area of training making it even more confusing.  For example: in WA state the required number of hours of training is 500 hours to take the test and become a licensed massage practitioner in WA. (From the WA State Board of Massage)

• 130 hours of anatomy, physiology, and kinesiology including palpation, range of motion, and physics of joint function. There must be a minimum of 40 hours of kinesiology.
• 50 hours of pathology, including indications and contraindications.
• 265 hours of theory and practice of massage, to include techniques, remedial movements, body mechanics of the practitioner, and the impact of techniques on pathologies. A maximum of 50 of these hours may include time spent in a student clinic. Hydrotherapy is to be included when consistent with the particular area of practice.
• 55 hours of clinical/business practices, minimally to include hygiene, record keeping, medical terminology, professional ethics, business management, human behavior, client interaction and state and local laws.
• Certification in American Red Cross first aid and American Heart Association Cardiopulmonary Resuscitation
• Four contact hours of training in HIV-AIDS in the following six topics: Etiology and epidemiology; Transmission and infection control; Testing and counseling; Clinical manifestations and treatment; Legal and technical issues; and Psychosocial issues. Training can be obtained from local community hospitals and colleges.

The NCBTMB requirements are:

• A minimum of 500 hours of instruction as follows:
  125 hours of body systems (anatomy, physiology and kinesiology)
  200 hours of massage and bodywork assessment, theory and application, in-class and supervised
  40 hours of pathology
  10 hours of business and ethics (minimum of 6 hours in ethics)
  125 hours of additional instruction in an area or related field that theoretically completes the massage program of study
• Graduate of a NCBTMB Assigned School Code with a current valid transcript submitted to NCBTMB

So more hours of pathology and anatomy are required by the WA State Board of Massage than for the so called National Certification in Massage meaning that if you want to be licensed in WA State you will need more hours than what the NCBTMB requires.

In New Mexico, the basic number of hours required is 650 with a specific number of hours in each of the following (from the New Mexico Board of Massage):

(650) hour program in massage therapy training.  The massage therapy training must meet the following minimum curriculum requirements:

1. 165 hours minimum of anatomy and physiology, to include:
   1. physiology;
   2. anatomy;
   3. kinesiology; and
   4. forty (40) hours minimum of pathology.
2. 150 hours minimum of training in massage therapy as defined in 16.7.1.7 NMAC.
   1. The massage therapy training shall include contraindications of massage therapy.
   2. A minimum of 100 hours of hands on training must be completed before the student is allowed to begin a clinical practicum as defined in 16.7.1.7 NMAC.
3. 75 hours minimum of general instruction to include.
   1. business;
   2. hydrotherapy;
   3. thirty (30) hours minimum of professional ethics;
   4. four hours of first aid; and
   5. four hours of cardiopulmonary resuscitation.
4. Electives may include:
   1. additional massage therapy;
   2. related hands-on modalities;
   3. additional anatomy and physiology;
   4. clinical practicum (not to exceed 150 hours);
   5. counseling;
   6. herbology;
   7. homeopathy;
   8. nutrition;
   9. breathing and stretching techniques;
   10. theory; and
   11. other courses with prior board approval.  See 16.7.4.14 NMAC for instructions.

So with such variations in the number of hours required by each state, to have a true “National Certification” would mean that each state would need to change the number of hours of training required.

Currently, if you want to practice massage in another state than the one that you were originally licensed in, you need to fulfill the requirements of that state.  Some states do have reciprocity already set up because they know the requirements of other states will meet their requirements.

There are also three different licensing tests being used by the states.  The NCBTMB offers two different tests and the Federation of Massage State Boards offers another. You will have to find out what your state excepts and fulfill those requirements for massage licensing.

Find out more about becoming a massage therapist.

Careers in Massage

National Certification in Massage Therapy

History of National Certification in Massage

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Florida State’s Bill SB 1860 (PDF)is threatening to stop massage therapists from being able to bill Personal Injury Protection insurance for people who are injured in a motor vehicle collision.  The Consumer Advocates Report states that “Average charges by massage therapists saw the greatest increase, increasing from $2,887 in 2005 to $4,350 in 2010.” which is up much more than orthopedic physicians and acupuncturists.  I think the bill is showing a big problem in the massage profession which is overbilling for massage services for car accidents.  While I do believe we need to fight this bill, the next step would be to look into the problem that brought this bill up and see what can be done to find out if there are many massage therapists who are overbilling or is it needed in the care of injuries sustained in car accidents.

The Florida State Massage Therapy Association has a call to action and you can find out more by asking on their Facebook group page.

Tennessee is also faced with HB 2387 that is trying to move massage therapy from the health related boards to that of the commerce and insurance division–the division that regulates “trades.” The biggest thing would be that massage therapy would then be considered a “trade,” not a “profession,” and insurance companies don’t pay tradespeople. They pay professional health care workers. It would also be a step down for the profession of massage overall moving to that of a trade division.

There is a petition for the TN bill “Stop the deregulation of Massage in TN”

Each state needs to keep up to date with the laws and legislative actions that are constantly  happening.  The current economy is challenging the budgets of many states and they are always looking for a way to lower expenses and make more too.

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You have to really do your research to find the best massage school for you.  It is often difficult to really know which career path is best for you since you are just starting out.  There are many different paths that careers in massage can take.  In general, they are as follows:

• Relaxation or Spa Massage Therapy – which is doing massage on people in spa settings mainly.  You can start your own spa or work for someone else.
• Medical Massage which is not a discipline in itself but a way to assess people’s conditions and diseases and apply a massage treatment to them.  It can be most any type of massage that works to show improvement.  Many massage schools may offer you a medical massage training course when there is no one technique that is ‘medical massage’.  Orthopedic massage, deep tissue massage, structural integration bodywork, cranio -sacral massage and many other types of massage are considered to be ‘medical’ in nature as in – they are able to address many medical conditions.
• Sports Massage is massage that focuses on athletes from every caliber from the weekend athlete playing soccer or tennis or something like that to a masters athlete who are serious amateurs to Olympic athletes and professional athletes.

So you also need a general idea of what area of training that you really want to start with.  You will be able to change at anytime or take one aspect of training and learn more as you go.  In fact, most massage therapists are continually taking continuing education classes partly because it is required to renew your massage license and partly because it is such a fascinating field with many things to learn.

The best way to get an idea of what areas you are interested is to get massage at various places like a spa, health clinic or other environment and talk to the massage therapists there to find out more and to actually experience the different types of massage for your self.

My Book – A Career in Massage – Is It For You?: The truth about becoming a massage therapist…what massage schools and associations don’t tell you about becoming a massage therapist. (Link goes to www.amazon.com)
will tell you more! It covers every thing you need to know about becoming a massage therapist and also covers how to choose the massage school that is best for you.

You can also start looking for massage therapy schools and learn more on my other website at www.massage-career-guides.com

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2. Chicago Massage Therapy Schools and Job Information
3. Researching Massage Schools

Lower back pain is reduced and range of motion increased after massage therapy. Hernandez-Reif M, Field T, Krasnegor J, Theakston H.

A randomized controlled trial of aromatherapy massage in a hospice setting. Soden K, Vincent K, Craske S, Lucas C, Ashley S.

Effects of massage therapy on sleep quality after coronary artery bypass graft surgery.

Parkinson’s disease symptoms are differentially affected by massage therapy vs. progressive muscle relaxation: a pilot study

Randomised controlled trial of the effectiveness of using foot reflexology to improve quality of sleep amongst Taiwanese postpartum women.

See more on massage and sleep disorders

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Research is an important part of the next steps for the massage profession.  The biggest reason is that it can help the massage profession and your massage business gain the respect that is needed by the general public and also the medical profession.  It will also help get massage covered by insurance.  One of the things that Debra Senn (a past insurance commissioner in WA State who made it possible for WA State MT to become contracted providers with insurance) said one of the most interesting things about the process.  She said when insurance companies first heard they were going to have to pay for massage, they complained thinking that it would cost them more money.  They thought they would have to pay $10,000 for the carpal tunnel surgery (or whatever type of surgery and that amount is just for example- how much does a carpal tunnel surgery really cost?)  and then pay a few extra thousand to cover the massage.  They did not understand that massage could eliminate the need for massage.  I still don’t think they really get it as what I see in the way of referrals from most doctors is generally for back and neck pain.  The doctors don’t really understand how massage can be used for various things like musculo-skeletal injuries such as plantar fasciaitis, tennis elbow, sprained ankles, and things like that.  Doctors will relate more to evidence and research that shows how massage can help.  They will also start getting it when more people provide start using massage for just those kind of issues and start giving feedback to the doctors.

One of the other things about research is that it is important to have research that shows what massage does.  Many of the things that are currently being taught in massage school are inaccurate and have just been handed down through classes because that is what they are taught.  There are still many schools saying that massage should not be used on people with cancer which was debunked many years ago. (See massage and cancer)   The other big myth is that of toxins being removed (See Massage and toxins) from the body through massage and also the myth that massage removes lactic acid. (See Lactating Mythers – Massage and the Lactic Acid Myth)   Right now there are many massage therapists that continue to say those things and don’t have the latest research that shows otherwise and having so much misinformation makes massage confusing to the general public.

But having more research is not really enough since most massage therapists are not research literate- that is the don’t understand how to evaluate a research study.  Just because a study was done and shows positive outcomes does not mean that it shows anything unless you can understand it.  Research literacy is needed and it begins with having to read and learn about things that most have no interest in.  Most massage therapists are just happy to be doing massage or are struggling to get clients or find a high paying job.  Who has time for research or learning any more when of course we already know that massage works?

Research Literacy according to Ravensara Traviallian from her article in Massage and Bodywork Magazine in the Research Perspectives column is :

the ability to read, understand, and
apply information from published
research—

Once you are research literate, then you have the opportunity to start influencing research and even creating research studies.

In your massage practice, you will be able to look up research to help you address the needs of your clients when they come in with more difficult diseases and conditions and when you want to know if massage can help them.  When clients ask you how massage works, you will be able to give a knowledgeable answer.  When clients understand more how their bodies work, they have the power to take care of it better.  They also may pass this information on to their doctors- and so it goes.

So please share your comments or insights as to why we do need research and need to also be able to understand research.

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3. Massage Research Resources