Massage Therapy Licensure vs. Certification: What’s the difference?

license-appRight now, the field of massage therapy is still in it’s Wild West phase. Sure we’ve come a long way in the past decade or so, with state regulations like licensure and certification. But what do those terms mean?

Massage therapists themselves are sometimes, understandably, unaware of the difference between massage therapy licensure vs. massage therapy certification. Consumers are most likely unaware of either, and assume that therapists must have some sort of legal authority to practice, but this isn’t always so. So, who sets the standards? Why is each state different? And why is it so confusing?

There are a lot of questions, but stick with me because we’re going to clear a few things up.

Licensed, certified, state certified–these terms are distinctly different, yet we hear them used interchangeably all the time. There are various resources on both ABMP and AMTA showing state regulations, and we used some of that information to put together this guide of state-by-state regulations…all in one place (current as of August 2013). Check out the slide deck and then we’ll define the terms and sort it out in the rest of this blog post.

regulatory-requirements-for-massage-therapy-1-638Regulatory Requirements for Massage Therapy from


Licensure is the legal authority to practice massage therapy, regulated by the state or local government. If you live in a state that has licensure requirements, then you cannot legally practice massage therapy without a license.

From the AMTA website: “Licensing it always based on the action of a legislative body. Once a licensing law has been passed it becomes illegal for anyone to engage in that occupation unless he or she has a license. The health care professions are typically licensed at the state and/or local level, but not usually at the federal level.”

  • Government regulated

  • Involuntary, required


Certification is the process of getting a professional association’s “seal of approval.” It shows that the person has achieved mastery in their profession, according to the organization’s standards. Certification has nothing to do with legal regulation. It’s an extra gold star on your resume, and possibly very valuable in demonstrating your particular knowledge and skills.

  • Non-governmental, professional organization

  • Voluntary

State Certification (this is where it can get really confusing)

Some states may not require licensing, but they do have certification requirements for those who wish to call themselves massage therapists. Clear as mud, right?

Here’s an example: in Indiana up until recently, anyone could call themselves a massage therapist without legal consequences. This left the door wide open for prostitution to masquerade as massage therapy. Indiana passed massage therapy certification requirements in 2007, which regulated the use of the professional title “massage therapist.” So Hoosiers may practice massage therapy without being certified, but they have to call themselves something else, like “body worker.”

  • Government regulation of professional title

  • Involuntary, if you want to use the title massage therapist, voluntary if you want to practice under a different title

State by state regulation (or not)

Depending on where you live and practice, your state may have licensure requirements, certification requirements, both or none. According to AMTA, 44 states have at least some regulation for massage therapists, 4 states have drafted or proposed legislation, and 2 states are completely unregulated (hi there, Vermont and Oklahoma).

Who sets the standards?

Here’s where the Wild West nature of massage therapy really comes into play. Not only do states differ on licensure vs. certification, they also differ on standards to some extent.

In states that regulate massage therapy, massage therapists must meet the legal requirements of that state to practice, which may include minimum hours of initial training and passing an exam.

In states that don’t regulate massage therapy, local municipalities may set standards.

Most states that license massage therapists require a passing grade on the Massage & Bodywork Licensing Exam (MBLEx) or one of two exams provided by the National Certification Board for Therapeutic Massage & Bodywork.

The American Massage Therapy Association and most other massage therapy organizations prefer the MBLEx, administered by the Federation of State Massage Therapy Board (FSMTB), as a state licensing exam. However, AMTA notes that they support the authority of regulatory boards to make those determinations.

Which is better?

Should states be pushing for licensure or certification, or no regulation at all?

State licensure has the most teeth as far as protection for professionals and consumers, just like any other health care professional must be licensed by the state. State certification is a step in the right direction and provides some protections as well, but is not quite as strong as licensure due to the loophole of practicing massage therapy under another title.

The consensus among professionals and associations like AMTA and ABMP definitely favor fair and consistent state regulation. Regulation is beneficial to public health, professional integrity, and consumer protections. Here are just a few of the benefits of regulation:

  • Established standards of minimum competency

  • Practitioners are qualified to be called massage therapists

  • Consumer protections by defining legal scope of massage therapy practice

  • Non-compliant practitioners can be disciplined

  • Consumers can file legal grievances, prevents unethical and/or non-compliant practice.

There are many many resources out there to help you understand what requirements are established in your state and how to apply for licensure/certification. I hope this helps you better understand the difference between the terminology of a massage therapy license and massage therapy certification.

I’d love to get your feedback on the issue, or questions about licensure vs. certification! Please share and respond in the comments below.

Comments from original Massamio post:

For the most part, I agree with the content of the article, and appreciate that there are many therapists out there who are unclear as to the differences between licensure and certification.  I must, however, disagree with your statement…  “State licensure has the most teeth as far as protection for professionals and consumers, just like any other health care professional must be licensed by the state.” The intent of state licensure is NOT to protect professionals. It’s full intent is to protect consumers. I believe there is confusion here not only in this blog post, but in the minds of many therapists. The only “protection” that could be considered for professional therapists is title protection, and I’m sure that many MT’s out there have experienced encroachment on their title from just about every healthcare profession. A word or words in a licensure law does not protect the title…..the actions of the legislation in response to encroachment protects the title. Doesn’t happen all that often.  The truth is there IS a distinct difference between licensure and certification. So clear, in fact that there should be NO confusion as to the difference. Unfortunately for the massage therapy profession,this is not the case. — Posted @ Monday, September 16, 2013 7:51 AM by Angela Palmier

Thanks for taking the time to write this post! This is a difficult area to navigate.   I’m pretty sure I know where all of the current confusion is going to lead us, but like everyone else in the profession, I’m only guessing as to what the future holds.   In Texas, my students complete a 600 hour program, and then take the MBLEX Exam. It’s all very straight forward. And at the end of the day, nobody cares how they got where they are.  For me personally, I have held a state license, and a National Certification in Therapeutic Massage and Bodywork for 18 years.   At the end of the month, I have to make the decision to renew my certification status. As of right now, the decision is going to be easy, I’m leaning toward not jumping through the hoops that the NCBTMB requires. My decision is due to a lack of trust in the organization, and my preconceived ideas as to where the standardization is headed for the profession as a whole.   Last year, I paid to renew my wife’s certification, and after a few interactions with the organization (read: NCBTMB), we still do not have a new certificate to show that she has met the requirement. The whole process was (and still is!) very discouraging to say the least. But in the end, it made my decision to renew much easier. — Posted @ Monday, September 16, 2013 2:30 PM by Rick Merriam

Thanks for exploring this topic. In California it is certainly all over the map with optional certification now available to override local municipal laws with 2 tiers: 250 and 500 hour levels of certification.  Here is the Silicon Valley, employers, like Google, are setting school educational standards higher than the state, requiring employees to have closer to 750 hours.  I think the most important thing is to have students have a quality education with well rounded experienced teachers.   Then, passing NCBTMB or MBLEx should be a breeze and students will be prepared to enter the field with confidence and skill. — Posted @ Wednesday, September 18, 2013 1:14 PM by L Golland

I have an Associates degree in Applied Health sciences Clinical And Therapeutic massage. I had over 1000 hours of classroom time. I took my National Exam passed with flying colors I have license number through the State of Indiana. I of course passed all the back ground checks paid my money have insurance am with the AMTA the IPLA but can’t call myself licensed . Sadly here in Indiana we do not have Licensure law . WAKE UP POLITICIANS HOW MANY CHAIR MASSAGES do we have to give you at the State office building LOL — Posted @ Tuesday, December 03, 2013 11:08 PM by Doug Herr CMT