Why
The IRS doesn't list massage. It falls under the general rule: medical care has to be primarily to alleviate or prevent a physical or mental disability or illness, and things that are merely good for your general health don't qualify.
Publication 502 allows therapy received as medical treatment. That's the route for massage: a practitioner has diagnosed a condition, such as an injury, and recommends massage to treat it.
What to keep
- A written recommendation from your practitioner naming the condition and the treatment, dated before you start.
- An itemized receipt for each session showing the date, provider and service.
Watch out for
- The IRS doesn't publish a letter of medical necessity form. What matters is that your records show the condition and why massage treats it.
- Spa memberships and relaxation packages are hard to defend even with a doctor's note.
If you plan to reimburse yourself later
IRS Notice 2004-50, Q&A 39, sets no deadline, as long as the expense came after your HSA was established and your records show it wasn't paid by another source or deducted on a tax return. See what records the IRS expects and how long to keep them.