RebloomaWhat we know, and where we learned it.
Plain explanations of how FSA and HSA money works, what the research says about massage, and links straight to the sources — so you can check anything we say.
FSA and HSA, in plain words.
An FSA is money taken from your paycheck before tax and set aside for health care. You choose the amount once a year. It is your money, but it usually has to be spent within the plan year — some employers allow a short grace period or a small carryover, and many allow neither.
An HSA works with a high-deductible health plan. The money is also pre-tax, it rolls over year to year, and it stays yours if you change jobs.
What makes an expense qualify is not the service on its own, but whether it treats a diagnosed condition. The IRS says plainly that general health and wellness spending is not a medical expense, which is why a letter of medical necessity, a clinical note and an itemized invoice matter so much.
Who decides is your plan administrator, not your therapist and not us. Documentation is what they weigh.
The documents we work from.
Publication 502: Medical and Dental Expenses
The list of what counts as a medical expense, and the rules behind it.
IRSPublication 969: HSAs and other tax-favored health plans
How HSAs, FSAs and HRAs work, including what happens to a disqualified withdrawal.
IRSFAQs on nutrition, wellness and general health
The 2024 guidance that draws the line between treatment and general wellness.
HealthCare.govUsing a Flexible Spending Account
The plain-English version, including grace periods and carryover.
HealthCare.govHow HSA-eligible plans work
What pairs with an HSA, and how the money is meant to be used.
NIH / NCCIHMassage Therapy: What You Need To Know
The federal research centre’s summary of the evidence, and its safety notes.
Massage, and the conditions it has been studied for.
The National Center for Complementary and Integrative Health, part of the NIH, reviews the evidence on massage therapy. Its summary: massage may help with some pain conditions, including low-back pain and chronic neck pain, and reviews have found improvements in pain, anxiety and depression for people with fibromyalgia when it continues over several weeks.
It also notes that massage appears to carry few risks when it is done by a trained practitioner, but that some health conditions call for precautions — a conversation to have with your own clinician.
Evidence is not a promise. It is a reason to ask a clinician whether massage belongs in your care, which is what the consultation is for.
Common techniques, and what they’re for.
Therapists usually combine several in one session. Knowing the words helps you describe what you need — and helps your note describe what happened.
Swedish
Long, gliding strokes over the whole body at moderate pressure.
Often the base of a session; on its own, usually for relaxation rather than treatment.
Deep tissue
Slower, firmer work into the deeper layers of muscle and connective tissue.
Persistent tightness, chronic back, neck and shoulder pain.
Myofascial release
Sustained, gentle pressure on the fascia, the sheet of tissue wrapping muscle.
Restricted movement, pain that spreads beyond one spot.
Trigger point
Focused pressure on tight knots that refer pain elsewhere.
Headaches, jaw pain, a shoulder that aches down the arm.
Sports and orthopaedic
Assessment-led work around a specific movement or injury.
Recovery, overuse injuries, returning to activity.
Prenatal and postpartum
Positioning and pressure adapted for pregnancy and recovery after birth.
Back and hip pain, pelvic changes, the load of carrying a baby.
Lymphatic drainage
Very light, rhythmic strokes that move fluid.
Swelling, post-surgical recovery, when a clinician has recommended it.
A session booked purely to relax is not a medical expense, whichever technique is used. What makes it care is a diagnosed condition, a treatment that addresses it, and a record that shows both.
Documentation, in short.
- checkWrite what you observed and did, not what you think the diagnosis is. The condition comes from the clinician’s letter; diagnosing is outside a massage therapist’s scope in most states.
- checkName the areas you worked on, and say whether they match the letter. When a session drifts, say why.
- checkRecord change over time: what your client reported, what you found, what you plan next.
- checkKeep the invoice clean: the treatment itemized on its own, away from tips, add-ons and retail.
- checkCheck your own state board for licensing, scope and record-keeping rules. They differ by state and they, not us, govern your practice.
More guides are coming.
Deadline checklists before year end, what to send an administrator, and how to talk to your therapist about a treatment plan. Waitlist members get them first.
Everything here is general information, not medical or tax advice. Whether an expense qualifies depends on your condition and your plan; whether it is reimbursed is decided by your plan administrator.