Turn Your Benefits Into Wellness
Use HSA/FSA for Medical Massage with i-thriv
Why this form?
To use HSA/FSA for therapeutic massage, most plans require:
This HSA/FSA Intake Form, and
A physician Letter of Medical Necessity (LMN) confirming medical need.
What this form does
Documents medical need (e.g., pain, injury, stress, prenatal).
Specifies massage type, session length, frequency, and total sessions.
Provides required provider info (incl. NPI) for reimbursement.
Creates a compliance record for i-thriv.
How to complete (step-by-step)
Client Section – Enter your contact info; check all health needs that apply.
Session Details – Choose the massage type, 60/90/120 min, frequency (weekly/bi-weekly/monthly/other), and number of sessions (1/2/4/8/12).
Physician Section – Obtain an LMN from your doctor (with diagnosis/ICD-10 if available).
Acknowledge & Submit
By submitting, you confirm all information is accurate and that you understand your plan’s HSA/FSA rules.
Sign and date the form.
Attach/upload the LMN with this form or have your physician email it to billing@i-thriv.com.
Questions or alternate submission? info@i-thriv.com.
After you submit
You will receive one invoice per session after each appointment.
We do not bill all sessions upfront; we bill one session at a time to meet typical HSA/FSA documentation requirements.
Your receipt will include all required provider details, including NPI , for your reimbursement submission.
Important notes
Plan approval is not guaranteed. Your HSA/FSA administrator makes the final decision.
HSA/FSA typically covers therapeutic massage (e.g., deep tissue, sports, prenatal, pain management) when supported by an LMN.
Not covered: spa parties, facials, yoga, sound baths, or other non-therapeutic services.
Need help?
Billing & LMN submissions:
General questions: info@i-thriv.com