Medical Massage Insurance Benefits, Made Clear

Announced NYSHIP / Empire Plan changes include a limit of 15 non-network therapeutic massage visits per calendar year and a $125 reimbursement cap per visit beginning January 1, 2027 for affected coverage groups. The changes that apply to you may depend on your bargaining unit, employment or retiree status, and plan provisions. Confirm your individual 2027 benefits with NYSHIP / The Empire Plan or your benefits office.

Source and scope: Article 9.15(b) of the 2026–2031 PEF/State PS&T agreement (PDF) sets these January 1, 2027 massage limits. PEF confirms the agreement was ratified August 18, 2026. This source establishes the change for that agreement; it does not establish identical benefits for every NYSHIP group. Confirm your own coverage with your benefits office.

Our $125 price and NYSHIP reimbursement are different

Our price: a 60-minute Medical Massage is $125, paid directly to Hands On HealthCare.

Your insurance benefit: the announced $125 reimbursement cap is a plan limit, not a promise that NYSHIP will reimburse your $125 payment. Deductibles, coinsurance, the plan’s allowed amount, visit limits, medical necessity and documentation requirements may affect your benefit.

How Do I Know If My Benefits Are Affected?

Contact NYSHIP / The Empire Plan or your benefits office directly before scheduling 2027 care. Our office cannot verify your union contract, retiree status, deductible balance, individual plan details or 2027 claim-processing rules.

Questions to ask:

• Am I enrolled in NYSHIP / The Empire Plan for 2027, and do the announced massage changes apply to my coverage group?
• What is my non-network deductible, and how much remains?
• For a covered massage visit with an actual charge of $125, how much will be credited toward an unmet deductible?
• After the deductible is met, what coinsurance applies?
• Is the $125 reimbursement cap applied before or after coinsurance, and how is the allowed amount determined?
• Is medical massage limited to 15 visits per calendar year, and do visits applied to the deductible count toward that limit?
• What documentation and claim form are required for patient self-submission?
• Will NYSHIP accept my itemized receipt/superbill, and is a prescription/referral required? What must it include?

Will Hands On HealthCare Submit NYSHIP Claims in 2027?

No. Beginning January 1, 2027, Hands On HealthCare Massage Therapy will not submit NYSHIP / Empire Plan claims directly. Patients will pay the practice directly and may submit their own claims to NYSHIP for consideration.

When the required medical documentation is on file, we can provide an appropriate itemized receipt/superbill for patient self-submission. NYSHIP determines whether the claim is eligible, how much counts toward the deductible and whether reimbursement is payable. A superbill does not guarantee coverage or reimbursement.

How Patient Self-Submission Will Work

Beginning January 1, 2027, you will pay Hands On HealthCare directly. If you choose to seek NYSHIP reimbursement, you will submit the claim yourself. Our office will not submit NYSHIP / Empire Plan claims on your behalf.

1. Confirm your benefits first. Ask NYSHIP whether your coverage includes the service, what deductible and coinsurance apply, and how the visit limit and reimbursement cap work for your coverage group.
2. Ask NYSHIP for its current submission requirements. Confirm the correct claim form, submission method, filing deadline, prescription/referral requirements and supporting documents. Do not assume a cash receipt alone is sufficient.
3. Complete the required office paperwork. Make sure your medical intake forms, diagnosis or medical reason for care, and valid prescription/referral when required are on file. We maintain treatment documentation and chart notes supporting the care provided.
4. Request an appropriate itemized receipt/superbill. When the required documentation is on file, we can provide this for your self-submission. Ask NYSHIP whether additional records are needed.
5. Submit and keep copies. Follow NYSHIP’s instructions and retain your claim, receipt/superbill and supporting documents. Review the explanation of benefits to see what was allowed, credited toward your deductible or reimbursed. Direct claim-status or payment questions to NYSHIP.

We cannot confirm exactly how NYSHIP will process patient-submitted massage claims in 2027. Confirm current requirements directly with NYSHIP; submitting paperwork does not guarantee that a claim will be approved or paid.

What We Can Do for You

We can provide skilled therapeutic care and organized documentation when proper paperwork is on file, including:

• A valid prescription/referral when required
• Completed medical intake forms and diagnosis or medical reason for care
• Treatment documentation and chart notes supporting medical necessity, areas treated, complaints, functional concerns and treatment response

Reimbursement Is Determined by NYSHIP

NYSHIP / The Empire Plan determines coverage, the allowed amount, deductible application, coinsurance, visit limits, medical necessity, documentation requirements and the final claim decision. Our office cannot guarantee payment or predict your individual reimbursement.

Some teachers, school employees, retirees, union members and public employees have coverage through other plans or different coverage groups. Confirm the plan you are enrolled in and which changes apply to you with your insurer or benefits office.

Your Care Can Continue

We understand that changes in insurance benefits can feel frustrating or confusing. Your benefits may be changing, but your care does not have to stop.

You may choose to continue with private-pay Medical Massage, discuss an appropriate visit frequency with your therapist, or seek reimbursement through patient self-submission when your plan permits it. You can also schedule remaining eligible 2026 visits while those benefits are available.

Hands On HealthCare has extensive experience with medical massage documentation, prescriptions/referrals, intake forms and organized patient records. We will continue providing skilled therapeutic care and appropriate documentation when the required paperwork is on file.

To schedule NYSHIP medical massage visits before year-end, please call 631-462-4263.