As the name implies, medical massage is a therapy prescribed by a physician and performed following the directives of that physician. The treatment does not necessarily have to take place in a physician’s office and in fact it would be quite unlikely for a massage service to be directly supervised by a physician. It is outside a therapist’s scope of practice to include any treatment that is not specifically directed, even if you believe that you know a better way to provide treatment than what the physician has prescribed. You may chose whether or not to bill insurance for this service, although it is wise to at least know how to do so, to create a lucrative business for yourself. If you are treating a private client without that physician’s prescription, you may still employ medical massage-based protocols; however, you cannot bill insurance and you are not restricted to a directive. In this instance, while you are working as a health care provider, technically speaking you are not providing a medical massage.