Medical Massage vs. Wellness Massage

The way I understand and practice them, medical massage and wellness massage are two entirely different services.

Medical massage is medical care delivered to a patient under the direction of a prescribing health care provider and typically paid for by a third party.

Wellness massage is a consumer service delivered to a client who pays for the service themselves.

The table below is my attempt to clarify and elaborate on the differences between these practices (another table illustrates how clinical massage and relaxation massage fit in). This is an early draft of a work in progress. If you have comments, criticisms, or suggestions please leave a comment below.

Medical Massage

Wellness Massage

commercial context

health care system

personal service industry

customer relationship



dominant paradigm

scientific, problem-solving

intuitive, nurturing

reason for treatment

medical necessity

client request


functional outcomes

client satisfaction

termination of care

maximum medical improvement (usually)

when client’s needs are met or change

primary massage treatment techniques

clinical massage techniques like myofascial treatments, deep tissue massage, cross-fiber friction, neuromuscular “trigger point” technique, and muscle energy technique

relaxation massage techniques like Swedish, deep tissue, circulatory massage, and craniosacral


rates set by UCR and RVU

rates set by the consumer marketplace

billing services

yes (discount for payment at time of service)

no (all payments due at time of service)


can take 30-90 days or longer

due at time of service




therapist accountable to

  • patients
  • IRS/state/local taxes
  • state/city licensing authorities
  • certification boards
  • referring providers
  • other HCPs involved with case
  • insurance companies
  • health care networks
  • attorneys
  • courts
  • independent medical examiners
  • auditors
  • clients
  • IRS/state/local taxes
  • state/city licensing authorities
  • certification boards

Medical Massage

Wellness Massage

time spent on documentation, coordination, and communication

5-20 minutes or more per session

1-5 minutes or less per session


basic 500-hour massage certification course plus advanced training in

  • orthopedic assessment & treatment protocols
  • pathologies and contraindications
  • medical terminology
  • pharmacology
  • documentation
  • communication skills

basic 500-hour massage certification course


need clinical and professional experience and/or an internship

can start practicing right after graduating from massage school

receiver’s emotional state/level of proactiveness

didn’t ask to be injured, may be depressed, anxious, or otherwise distressed by both the injury/accident and/or ensuing work, life, and health complications

proactively seeking care, typically healthy and active

physical demands on practitioner

can be heavy – orthodpedic assessments, muscle energy techniques, myofascial treatments, cross-fiber frictioning, and other injury-treatment techniques can be hard on your body

may be lighter – Swedish and some other techniques are less demanding, but deep tissue massage can be hard on your body

emotional demands on practitioner

can be heavy – patients can be disengaged, distraught, or otherwise unengaged or difficult to engage

typically light and/or manageable

client education

may be OK (therapist should ask the prescribing referrer about this), but shouldn’t contradict what the rest of the medical team is saying

OK within scope of practice (“drink plenty of water,” “do that stretch I showed you,” “put an ice pack on it,” etc.)

marketing model

business-to-business networking with referring providers, health care networks, etc.; many legal and ethical considerations regarding referral relationships, etc.

consumer marketing (much like a tax preparer, hair dresser, real estate agent, etc.); gift certificates, referral discounts, and other consumer marketing practices are OK

Medical Massage

Wellness Massage

Clinical Massage vs. Relaxation Massage

Two other terms often arise in the process of distinguishing between medical massage and wellness massage. I primarily use clinical massage techniques, and approach my work with a clinical intention, in my medical massage practice, but I also take a clinical approach with some of my wellness clients. Similarly, I primarily use relaxation massage techniques in my wellness practice, but sometimes doctors prescribe massage for its relaxation benefits, so I sometimes use it in my medical practice. Here’s a graphical look at this idea:

Commercial Context

Medical Massage

Commercial Context

Wellness Massage

Treatment Intention

Clinical Massage

Problem-solution, “fixing” approach. Many assessments and systematic application of clinical massage techniques.

Treatment Intention

Relaxation Massage

Intuitive, nurturing approach. Creative selection of techniques. Can be mellow spa-like atmosphere, meditative, chatty and educational, or lively and invigorating, depending on client or patient needs.

Please be relevant, civil, and polite when you comment. I reserve the right to delete comments that are offensive or off-topic.

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12 thoughts on “Medical Massage vs. Wellness Massage

  1. Hi, this is good.

    Does a licensed massage therapist, who is also nationally certified in neuromuscular therapy, and certified in manual lymphatic drainage and complete decongestive therapy have to also have a “medical massage” certificate to be able to deliver “medical massage” and have the services paid by a third party (i.e. insurance company)?

    Thought I’d ask you as I don’t know for sure.

    Thanks for you time Larry. I live in Florida

    • As far as I know, there is no additional requirement beyond your state license (and possibly your credentialing with managed-care networks) to deliver medical massage and bill insurance companies. If I learn differently, I’ll post the info to the website.

  2. hi, larry, i liked this info.. very good stuff.. I am a new therapist and
    i would like to one day start my own business.. I first want to
    get my feet wet and work for a doctor or phyiscal therapist..I’d like to know
    a liitle more about billing insurance.. I live in Texas.. DO u know
    if it’s approved here ? THanks..

  3. Wow, I hope your readers do their research. Yes I practice wellness massage & have all but one or two training skills you mention. Many colleges offer over 750 hrs. Of training not including volunteer work throught out the duration of our education. As for massage treatments we are trained in all or most of what you have list: I think 1-5 per sesion is a type o, right?, no harm done. It is good to question the difference liken the difference b/w misuse and therapist. Therapist receive academics in medical ed. Thank you for bringing up the conversation it was a good chat. CA Massage Therapist

  4. Hello Larry,

    Thank you for this great information. I have been providing massage therapy to hospice patients for the past 5 years and it was especially helpful to see in print the emotion challenges of medical type massage. For quite a few Pts, massage was elected by someone else and it takes time to engage them. Or they are so distressed by their prognosis and or failed treatment regime that they are not even connected to their bodies.

    I am in the process of starting my own business because the hospice organization cannot pay me a sustainable income. It kills me. They are so rich and use massage to get the leading marketing edge…. What I do appreciate about them is that each person entering hospice has the option for massage. Since medicare etc. does not reimburse for massage I don’t know how to get paid except to provide care only to those who can afford it.

    One idea is to become a non profit and grant writing. Any ideas or suggestions anyone has would be appreciated.

    Thank you,

  5. I am very surprise to get this information on this links from my teacher. She always sharing information that she known and think that will work/useful for her students. After reading the comparation between medical massage and wellness massage … it’s very useful for me! I am still in massage school learning about massage and may use this information in the future for talking to client and be able to explaining to them the different between these two massage. As I know that wellness massage usually do not get paid by health insureance and must be paid full price at the time of customer service . Sessions for the full body treatment within half hour or 60 minutes….and they might get the result after massage. Result is: relaxation, decrease tight muscle, pain, soothing tired muscles, improve circulation, and promotes an overall sense of happiness. Medical Massage is focuses on the areas have problems and treat the cause of pain. Medical massage take your personal insurance and required prescription from a doctor and only the area is determined by your doctor in treatment sessions. And the length of the session is determined by the number of treated area (until you get well)

    Again, thank you for sharing this information so we can exchange ideas with each other by comparing these two kind of massage!

  6. Hey Larry,

    I am a Medical Massage therapist. I have over 1750 hours in my AA degree and 4 years internship. The biggest difference between Medical Massage and Wellness Massage is that we treat pathologies. There are specific treatments for Thoracic Outlet syndrome, Carpel Tunnel Syndrome, Frozen shoulder, scoliosis, etc. I offer treatments rather than 60 or 90 min massage and it does take time to “fix” the problem. I go by percentages and have my clients/patients come in once a week until the issue is resolved then come in once a month for maintenance if it’s needed. I am also trained in Orthopedic testing, along with all the rest you mentioned. Travell and Simons Myofascial Pain and Dysfunction vol 1 and 2 are good books to become familiar with if you are interested in learning more. A “cliff notes” version would be The Trigger point manual by Clair Davies. It is very hard on the hands and the body to this type of work, so if you decide to pursue it, make sure you have someone who can treat you who does similar work. The Medical Massage Office is a great tool to help with paperwork and filing insurance. Personally, I’ve moved away from a clinical setting and now work in a Wellness Spa (though I don’t do any spa therapies), my clients come with issues from their doctors and pay me directly. I now come under the heading of Holistic Healthcare Practitioner. I hope this was helpful.

  7. Hello, I am currently a student at the clinic mentioned above in the website and was looking for a little clearer explanation of the difference between relaxation and clinical massage. Also is there a difference between medical and therapeutic massage or is it just because of where the massage is preformed( in a hospital instead of a clinic)? And if there is what is it. Aloha.

  8. Hi Larry,

    Thank you so much for this information – and I have referenced your site several times through the years, always such a pleasure and great resource. I have recently treated a client for 32 visits of medical massage after an accident, and the insurance company is now stating that they are going to pay me the ‘standard massage rate’ for my area – I have never heard of such a thing. I have not agreed to this, and feel that I should be compensated at the full rate as I billed by the unit of treatment for medical massage (and I definitely used all my clinical techniques and know how), not for an hour of swedish massage (as my soap charts prove). I was shocked at their reply and know for a fact that my rates are very close to other companies nearby that offer medical massage. I would like to find some proof that I have the right to charge for medical massage diffently than swedish so I can send it to them, in argument for payment. Do you know anyplace that outlines the legal standings we have to bill different prices? (or a site to direct me to). Thank you – KH Tacoma, WA

    • Hi, Kass:
      The insurance companies don’t set, and can’t dictate, “standard massage rates.” The correct lingo is “usual, customary, and reasonable” (UCR) rates, and those are typically based on either the information in the “National Fee Analyzer” book or by calculations based on Medicare’s Relative Value Unit (RVU). The insurance companies can’t unilaterally reduce your reimbursement, and if they do you can file a complaint with the state insurance commissioner. I have found that simply sending a letter stating the I charge UCR rates and won’t accept a reduction usually gets me paid in full. I am not an attorney, so I can’t speak to the legal issues. You might want to consult with Richard Adler at Adler Giersch or John Peick at the Peick Law Group.
      Hope this helps,

  9. Great article. I recently moved from Cincinnati, OH to Miami, FL. My asthma specialist in Cincinnati suggested that I see a medical massage therapist for some muscular related breathing problems. I am finding it hard to located a reputable medical masseuse in Miami. Are you aware if there is a national network for patients to find medical massage therapists? Also, do you know if there are certain requirements one must fulfill before they can advertise as being a “medical masseuse?”

    Thanks so much!

    • There’s no organization that I know of that lists medical massage therapists. Frankly, the term can be used by anyone who does massage in a medical setting. I would look for a therapist who has a good reputation with local doctors.