Yes, you can use your FSA or HSA for many recurring wellness services, including gym memberships, massage therapy, chiropractic care, acupuncture, personal training, yoga or pilates classes, and nutrition counseling. Each becomes eligible when it's tied to a specific diagnosed condition through a Letter of Medical Necessity (LMN) from a licensed clinician. The LMN is the documentation that converts an otherwise-personal expense into a qualified medical one.

TL;DR

• A Letter of Medical Necessity (LMN) from a licensed clinician converts otherwise-personal recurring wellness expenses into qualified medical ones for FSA and HSA purposes.

• One LMN can cover only one service tied to the same condition (an LMN each for a gym membership, group classes, and a personal trainer, for example).

• Services that commonly become eligible with an LMN: gym memberships, massage therapy, chiropractic care, acupuncture, personal training, yoga or pilates studios, nutrition counseling.

• The clinician must determine medical necessity for a specific diagnosed condition, and the LMN must predate or be on the same day as the expense.

• Burst issues clinician-reviewed LMNs in minutes and supports reimbursement filing for any of these categories.

Request your LMN →

What does "FSA or HSA eligible with an LMN" mean?

Some expenses are obvious. A prescription, a doctor's visit, a pair of crutches. The IRS lists these as qualified medical expenses under Publication 502. You can pay for them with FSA or HSA funds directly, no extra paperwork.

Other expenses sit in a gray area. A gym membership, a deep tissue massage, a chiropractic adjustment, a nutritionist visit. These can serve a medical purpose or a wellness purpose, and the IRS draws a line between the two. The rule in both Pub 502 and Publication 969 is the same: an expense qualifies if it diagnoses, cures, mitigates, treats, or prevents a specific disease, or affects a structure or function of the body. General health, fitness, and well-being do not qualify.

A Letter of Medical Necessity is the documentation that moves a gray-area expense onto the qualified side of that line. It captures, in writing, a licensed clinician's determination that a specific service is medically necessary for a specific patient's specific condition. With the LMN on file, the expense is recognized as a qualified medical one for the duration the letter covers, and you can use pre-tax FSA or HSA funds to pay for it (or reimburse yourself for it).

Without an LMN, the same purchase is a personal expense. Using HSA funds for a personal expense triggers income tax on the amount and a 20% penalty if you're under 65, so the documentation is not optional.

What is a Letter of Medical Necessity?

A Letter of Medical Necessity (LMN) is a written statement from a licensed healthcare provider. It names the patient, the diagnosed condition, the recommended service or product, and the clinician's signature, license number, and date. A well-written LMN ties the recommendation to the condition explicitly. It explains why the service is necessary, not optional. The clinician's medical judgment is what gives the letter its legal weight.

Burst LMNs are issued by US-licensed clinicians, are valid for up to 12 months, and can cover a basket of related recurring expenses for the same condition. Each LMN can cover one of a gym membership, studio classes, a personal trainer, and a Theragun all under the same diagnosis. You need a new letter for each line item as long as each it's covering a different product or service.

For a deeper explanation of how LMNs work, what's on the letter itself, and the difference between an LMN and a prescription, see The Ultimate Guide to Letters of Medical Necessity.

Which recurring wellness services can be made FSA or HSA eligible?

The categories below are the recurring wellness services most commonly converted to FSA or HSA eligibility through a Letter of Medical Necessity. Each has its own dedicated guide with the full condition list, provider examples, and step-by-step process.

Gym memberships

A gym membership becomes eligible when a clinician determines that regular exercise is part of treating a specific condition. Commonly qualifying conditions include obesity, Type 2 diabetes, hypertension, hyperlipidemia, cardiovascular disease, osteoarthritis, chronic low back pain, depression, anxiety, prediabetes, and sarcopenia. The LMN covers any gym or studio (Equinox, Life Time, 24 Hour Fitness, Planet Fitness, YMCA, Anytime Fitness, and many more). For the full breakdown, see How to Use FSA & HSA for a Gym Membership.

Massage therapy

Massage therapy becomes eligible when a clinician documents that it's part of treating a musculoskeletal, neurological, or chronic pain condition. Commonly qualifying conditions include chronic low back pain, fibromyalgia, sciatica, migraine, anxiety, post-surgical recovery, soft-tissue injury, osteoarthritis, and chronic stress with documented physical manifestations. The LMN covers recurring sessions at licensed massage therapists, physical therapy practices, or wellness clinics. See How to Use FSA & HSA for Massage Therapy.

Chiropractic care

Chiropractic care for acute conditions is often FSA or HSA eligible without an LMN. Maintenance care, recurring adjustments beyond acute treatment, and chiropractic services tied to long-term conditions typically require an LMN. Commonly qualifying conditions include chronic low back pain, neck pain, herniated disc, sciatica, scoliosis, osteoarthritis, and migraine. See How to Use FSA & HSA for Chiropractic Care.

Acupuncture

Acupuncture is recognized by the IRS as a qualified medical expense in many cases without an LMN. For recurring, maintenance, or wellness-oriented acupuncture, an LMN is often the cleanest path to documentation. Commonly qualifying conditions include chronic pain, migraine, fibromyalgia, anxiety, depression, insomnia, fertility-related treatment, and nausea (including chemotherapy-related). See How to Use FSA & HSA for Acupuncture.

Nutrition counseling

Nutrition counseling with a registered dietitian (RD) or registered dietitian nutritionist (RDN) becomes eligible when tied to a diagnosed condition. Commonly qualifying conditions include obesity, Type 2 diabetes, prediabetes, hyperlipidemia, hypertension, eating disorders, celiac disease, irritable bowel syndrome, food allergies, and certain cancers (post-diagnosis nutrition support). See How to Use FSA & HSA for Nutrition Counseling.

Personal training

Personal training becomes eligible when a clinician documents that supervised exercise is medically necessary. This is often paired with a gym LMN under the same diagnosis. Commonly qualifying conditions include the gym conditions above, plus post-surgical rehabilitation, post-injury recovery, neuromuscular conditions, and chronic conditions where unsupervised exercise would carry meaningful risk. See How to Use FSA & HSA for a Personal Trainer.

Yoga and pilates studios

Boutique yoga and pilates studios fall under the same framework as gyms. The LMN must tie the activity to a specific condition where the modality is medically appropriate. Commonly qualifying conditions include chronic low back pain, osteoarthritis, fibromyalgia, anxiety, depression, post-natal recovery, and balance or fall-prevention concerns in older adults. The LMN covers studios like CorePower Yoga, Club Pilates, YogaWorks, and most independent studios. See How to Use FSA & HSA for Yoga or Pilates.

Which medical conditions support these services?

The matrix below shows the most common combinations. A check mark means there is well-documented medical literature supporting the service as part of treating that condition. It does not mean every patient with that condition will qualify for that service. Your clinician makes the determination based on your specific case.

If your condition is on this list, the corresponding services are likely defensible with a well-written LMN. If your condition isn't listed, that doesn't mean you don't qualify. Burst's clinical team reviews each case individually.

How to use your FSA or HSA for wellness services: step-by-step

The process is the same across all seven categories. Get the order right.

Step 1: Get your Letter of Medical Necessity first

Request the LMN from a licensed clinician before you sign up for the service or before your next renewal date. The clinician reviews your medical history and, if appropriate, issues a dated letter naming the diagnosis and the recommended service or services.

Common mistake: paying for the service first and trying to get the LMN later. The IRS requires the medical-necessity determination to predate the expense. Months or sessions you paid for before the LMN's effective date are typically not reimbursable.

Step 2: Pay for the service with personal funds

Most wellness providers (gyms, massage therapists, chiropractors, acupuncturists, nutritionists, personal trainers, yoga studios) don't accept FSA or HSA cards at point of sale. Pay with a personal credit or debit card and save the itemized receipt.

Common mistake: trying to use your FSA or HSA card directly at the provider. Most aren't coded under the merchant categories that FSA and HSA card networks recognize as medical. Pay with a personal card and reimburse yourself afterward.

Step 3: Submit for reimbursement to your FSA or HSA administrator

Log into your FSA or HSA portal (provided by your employer or HSA custodian) and submit a reimbursement request. Attach the LMN, the dated receipts for the service, and any required claim form. Funds typically deposit to your linked bank account within one to two weeks.

Common mistake: submitting the receipt without the LMN. Administrators reject the claim if the documentation doesn't establish medical necessity.

Step 4: Keep your records

Hold onto your LMN and all related receipts for at least three years. The IRS audit window for HSA withdrawals is open during that period, and your administrator may ask for documentation if any claim is selected for substantiation.

Common mistake: discarding the LMN after your first reimbursement. You need it on file for the entire validity period and for the audit window after that.

How Burst makes this work for the full category

Burst issues clinician-reviewed Letters of Medical Necessity for all of the categories on this page. You complete a short medical-history form online, a US-licensed clinician reviews it (often the same day), and your LMN arrives by email valid for 12 months. The LMN is scoped to your condition, which means it can cover multiple eligible services at once. If you have chronic low back pain, the same letter can cover your gym membership, your monthly massage, and your weekly yoga class. After you pay for any of these services, Burst's reimbursement assistant helps you file the claim with your FSA or HSA administrator and track it through to deposit.

Request your LMN →

Frequently asked questions

Can one LMN cover multiple types of services?

Yes. A well-written LMN is scoped to a diagnosed condition and the medically necessary services for treating it. If your clinician recommends exercise, manual therapy, and nutrition support for the same condition, one LMN can cover a gym membership, a massage therapist, and a registered dietitian for the validity period. You don't need a separate letter for each provider.

How long is an LMN valid?

Burst LMNs are valid for up to 12 months from the date of issuance unless the clinician specifies a shorter period. The duration covers recurring expenses (monthly gym dues, weekly massages) for the entire window. You renew annually if the underlying condition still warrants the recommendation.

Can I use my FSA or HSA card directly at wellness providers?

Usually not. Gyms, massage therapists, chiropractors (for non-acute care), acupuncturists, nutritionists, personal trainers, and yoga or pilates studios are almost never coded under the merchant categories that FSA and HSA card networks recognize as medical. You pay with a personal card and reimburse yourself through your administrator.

Are virtual or app-based wellness services LMN-eligible?

Yes, with the same documentation. A telehealth nutrition consultation, an online personal training subscription, or a digital cognitive behavioral therapy program can all qualify with an LMN tied to a diagnosed condition. The clinician must determine medical necessity the same way as for in-person services.

What happens if my LMN gets audited?

Your administrator or the IRS may request documentation showing the LMN was issued by a licensed clinician, the diagnosis is real, and the recommendation is genuine. Keep your LMN, dated receipts for every service, and any related medical records on file for at least three years. A properly issued clinician LMN typically passes audit; vague or self-issued documentation may not.

Can I pay for a family member's wellness services with my HSA?

Yes, if they're a tax dependent and the LMN is issued in their name with a qualifying diagnosis. Spouses and qualifying dependents (children, sometimes elderly parents) are eligible. Each person needs their own LMN; your LMN can't cover theirs.

Are wellness equipment purchases covered by the same LMN?

Often, yes. If your LMN supports exercise for a specific condition, the same letter can cover related equipment purchases (a Theragun, a treadmill, a heart-rate monitor, an Oura ring) as long as each item is medically supported by the diagnosis. See 50 Everyday Products You Can Make FSA/HSA Eligible with an LMN for the full equipment side.

Do I need a new LMN every year?

Yes, in most cases. LMNs are typically valid for up to 12 months. To continue using FSA or HSA funds for the covered services beyond that, renew the LMN with a clinician who can confirm the condition and the recommendation are still active.

Related guides

• How to Use FSA & HSA for a Gym Membership

• How to Use FSA & HSA for Massage Therapy

• How to Use FSA & HSA for Chiropractic Care

• How to Use FSA & HSA for Acupuncture

• How to Use FSA & HSA for Nutrition Counseling

• How to Use FSA & HSA for a Personal Trainer

• How to Use FSA & HSA for Yoga or Pilates

• The Ultimate Guide to Letters of Medical Necessity

• 50 Everyday Products You Can Make FSA/HSA Eligible with an LMN

Written by Shubhi Jain, Co-Founder at Burst. Medically reviewed by Chris Walker, Allstar Medical Group. Last updated 2026-05-20.

This article is for general informational purposes and is not medical, tax, or legal advice. Consult a licensed clinician about your specific medical situation and your FSA or HSA administrator about your specific account rules.