How You Can Use a Letter of Medical Necessity

by Elyse Hoffman

What is a Letter of Medical Necessity? 

A letter of medical necessity (LMN) is like a doctor’s statement or note. It is a letter written by your doctor that verifies the services or items you purchase for the diagnosis, treatment, or prevention of a disease or medical condition.  

Why would you need a letter of medical necessity? 

Some items are only FSA/HSA eligible if you obtain a letter of medical necessity. In short, this letter verifies that the primary reason for purchase is primarily for medical care and is typically required by the IRS for certain eligible expenses.  

This letter verifies the services or items you are purchasing with your pre-tax healthcare dollars are for the purchase of diagnosis, treatment, or prevention of a disease or medical condition.

What types of products are FSA/HSA eligible with a Letter of Medical Necessity? 

1. Massage Therapy

  • Massages and massage therapy are not typically FSA (Flexible Spending Account) eligible because it falls under the category of “general health” which means while it can improve your wellness, its primary use is not to treat a specific medical condition.
  • However, if a healthcare professional deems massages a vital and necessary treatment to alleviate a medical condition, it may be eligible for a letter of medical necessity.  

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2. Baby Formula

  • Baby Formula is not FSA eligible because it falls under the category of “general health.” However, if your baby has an allergy to a specific ingredient found in traditional formulas or a medical condition that means they must use a specific formula, you may be able to be reimbursed for the difference in cost with a letter of medical necessity.  

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3. Ear Plugs

  • Ear Plugs are not FSA eligible but maybe with a letter of medical necessity. If you have a medical condition that requires ear plugs, talk with your doctor to get them reimbursed.  

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4. Air Conditioner 

  • An Air Conditioner for typical use is not FSA eligible. However, if the primary use of the air conditioner is to treat a medical condition, it may be eligible. For example, if you suffer from allergies and an air conditioner helps keep the windows closed so you do not have symptoms, it may be eligible. 

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5. Nutritionist

  • For a nutritionist to be FSA eligible, you must show that the nutritionist is used to alleviate or treat a specific medical treatment and not just to improve overall general health.  

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