How to Work in the U.S. As a Foreign-Educated Massage Therapist

Massage therapists are known by different names, such as masseuse, masseur, and bodyworker. But no matter the title, a license is usually required to practice in the United States.

The good news is that most US states welcome massage therapists who were trained in other countries. As long as you can show proof of your education and pass the national exam, and sometimes a state exam, you’ll most likely be eligible for a license.

While the process is usually straightforward, aspiring therapists can sometimes feel overwhelmed when getting their license. But with some patience, you should be able to continue your career in the United States by getting your education and hands-on experience recognized.

In this guide, we walk you through the key steps to getting your license and moving forward in your career.

In this guide, we will answer the following questions:

Why Become a Massage Therapist in the U.S.?

You may be asking yourself if getting licensed as a massage therapist and starting your career is worthwhile. So let’s look at the career field.

Job Outlook and Salary

According to Indeed.com, the average hourly pay for massage therapists across the U.S. is around $40 an hour.

Similarly, the U.S. Bureau of Labor Statistics estimates the median salary for massage therapists in America to be about $57,000, and says the job market is growing much faster than the average compared to other occupations.

So, not only can this career be financially rewarding, but it also offers strong job security. Later in their careers, many massage therapists also choose to build their own private practices, which can increase their earning potential and create even greater career stability.

Career Growth and Specialization Options

Beyond the financial benefits, massage therapists play an important role in improving physical health, reducing stress, and supporting overall well-being. As your career evolves, you can specialize in areas like sports massage, prenatal care, or chronic pain management. Finding your niche can open doors to higher earnings, stronger connections with clients, and a deeper sense of belonging within a professional community.

Now that we’ve covered the career opportunities and earning potential, let’s take a look at the steps you need to take to begin your journey as a licensed massage therapist.

Understanding Licensing Authorities

National vs. State Responsibilities

One of the first things you need to understand is which authority is responsible for granting your massage therapy license.

Massage therapists use touch to relieve pain, reduce stress, and support healing. Because they often work with clients in vulnerable physical and emotional states, it’s essential that they meet professional standards of training, safety, and ethics. For this reason, each state that regulates massage therapy requires practitioners to be licensed before they can begin working.

The most important national organization involved in this process is the Federation of State Massage Therapy Boards, commonly referred to as FSMTB. This organization provides guidance to state licensing boards and oversees the Massage and Bodywork Licensing Examination, or MBLEx, which is used in most states as part of the licensing process.

Another national organization that supports massage therapists is the American Massage Therapy Association, which is known as AMTA. This group provides resources, continuing education, and professional support to massage therapists nationwide.

Although there are national organizations, your license will still be issued by the state where you plan to work. For example, in Texas, your license is issued by the Texas Department of Licensing and Regulation, while in Florida, it is issued by the Florida Board of Massage Therapy.

To find the website for your state’s licensing board, you can use the directory provided by the Federation of State Massage Therapy Boards. The page includes links to the official licensing authority for every state and territory that regulates massage therapy in the United States.

We will also provide contact information for the licensing boards in Texas, Florida, New York, and New Jersey, as these are four of the most common states where massage therapists begin their careers in the United States.

How to Contact Your State Licensing Board

Now, let’s discuss the most effective way to communicate with your licensing board.

First, if English isn’t your first language, consider writing your email or letter in your native language and then translating it to make sure it’s clear. We can help with professional translation services into English to make sure your message is accurate and easy to understand.

In your communication, be sure to include all relevant details. This includes your full name, phone number, mailing address, and email address so the board can easily respond to you.

If you prefer to speak directly with the licensing board, keep in mind that office hours are typically from 9 am to 5 pm, Monday through Friday. Also, remember that the U.S. spans several time zones, so it’s a good idea to look up the local time of the state board you want to call.

Credential Evaluation for Foreign Education

What Is Credential Evaluation?

If you were trained in massage therapy outside of the United States, you will likely need to have your education reviewed by a credential evaluation company.

According to the MBLEx handbook, this process is called an “independent equivalency evaluation of your massage therapy education.” And it’s required so your training can be compared to the standards used in the United States.

This step is also important because the FSMTB, which manages the MBLEx, allows each state to decide whether a candidate’s education is equal to what is required in that state. Then, the results of your evaluation help the state licensing board decide if you are eligible to take the exam.

How to Choose an Evaluation Service

To begin, you will need to choose a credential evaluation service that is accepted by the licensing board in the state where you plan to apply. Some states provide a list of approved companies, while others allow you to choose from several well-known services. The best thing you can do is contact your state board and ask if they have a preferred provider.

Required Documents and Cost

These evaluations usually cost between $200 and $400. The processing time can range from just a few days to about four weeks. But, if you are in a hurry, many companies offer faster options for an extra fee, which usually ranges from $80 to $150. After the evaluation is finished, the company will send the results to both you and your state licensing board.

As you’re deciding which type of evaluation you want, choosing a detailed one, often called a ‘comprehensive’ or ‘Course-by-Course Evaluation,’ is probably best. This will make sure your state licensing board has all the necessary information from the beginning, which could help speed up the process.

To use a credential evaluation service, you’ll need to gather a few important documents, including your original degree certificate or diploma, transcripts, and mark sheets. And, if your documents are not in English, they will almost always need to be translated by a certified translator.

Certified Translations

Why Certified Translations Are Required

It’s important to understand that, even if you are fluent in English, you are not permitted to translate your own documents. In most cases, evaluation agencies will provide you with various options depending on whether you are going to have your documents translated in the U.S. or abroad. So, be sure to check with the evaluation agency because they may have certain requirements.

Some evaluation agencies may offer translation services for a fee; however, since US Language Services specializes in translation, our rates are usually much more competitive, and can be as much as 50% less than what evaluation agencies charge. Also, if the agency or the board needs the translations to be sent directly to them, we are happy to do so.

What Certified Translations Do—and Don’t Do

It’s important to understand that certified translations do not indicate the direct correspondence between a degree obtained abroad and its equivalent in the US.

Certified translations convert your documentation into English, allowing the evaluation agency or licensing board to review your academic and professional accreditations.

Certified translations do not change the value of a mark obtained. For example, if you earned a 10 in a subject in a country where subjects are numerically evaluated from 1 to 10, your certified translation will indicate that you earned a 10, not an A+.

In addition to any document required for the credential evaluation process, you may want to have any letters of recommendation or certificates of work experience translated for future job applications.

To obtain a certified translation from U.S. Language Services, you can place your order through our website or request a quote. You can simply send us scanned documents or even photographs of them; it is not necessary to send the physical documents for this part of the process.

English Proficiency for Massage Therapists

Why English Skills Matter

To succeed as a massage therapist, you’ll need excellent English Skills.

Even though you’re likely to work with clients from all kinds of backgrounds and the MBLEx is offered in both English and Spanish, fluency in English can help you find a job and communicate with your clients.

For starters, English proficiency will help you explain treatments clearly to clients and allow you to write accurate and detailed session notes. Strong English skills also make it easier to communicate with coworkers and healthcare professionals, such as physical therapists, chiropractors, or doctors, when needed.

Because communication is such a key part of the job, demonstrating a high level of English can also increase your chances of getting hired. Employers often seek therapists who can confidently answer client questions, explain treatment plans, and handle scheduling and billing without confusion.

Optional English Exams

Even if your state does not require an English exam, taking one can be a great way to show initiative and add value to your resume. Two of the most common English proficiency exams in the United States are the TOEFL, which means Test of English as a Foreign Language, and the IELTS, which stands for International English Language Testing System.

The best thing you can do if you are unsure about needing an English proficiency exam or which one to take is to reach out to the state board where you want to work.

National Licensing Exams

Overview of Massage Therapy Exams

Before we discuss the MBLEx in depth, it’s worth noting that there are other national massage therapy exams.

Still, none are as widely accepted as the MBLEx, which is currently recognized in 46 of the 49 U.S. jurisdictions that regulate massage therapy. But let’s take a quick look at the others.

One common exam that you’ll sometimes see mentioned on state licensing board websites is the BCETMB, which is short for the Board Certification Exam for Therapeutic Massage and Bodywork. It’s offered by the National Certification Board for Therapeutic Massage and Bodywork, and while the BCETMB isn’t accepted everywhere, a few prominent states like New Jersey and Florida do recognize it. The exam costs $275, consists of 140 multiple-choice questions, and you’ll have 140 minutes to complete it. For more information regarding the exam, you can take a look at the online candidate handbook.

Another exam you’ll sometimes see that’s accepted by a few states is the Asian Bodywork Therapy Exam offered by the National Certification Commission for Acupuncture and Oriental Medicine, or the NCCAOM. However, as of 2024, the NCCAOM stated that they have stopped offering examinations for their bodywork program. So, even though you may see this exam mentioned on your state board’s website, it’s no longer an option for massage therapists.

What to Expect on the MBLEx

To become a licensed massage therapist, you need to pass the Massage and Bodywork Licensing Examination.

The Massage and Bodywork Licensing Examination, or MBLEx, is the national exam that most massage therapists need to pass in order to get licensed. We’ll take a look at licensing rules in some popular states for immigrants in the United States a little later, and you’ll see that there are a few exceptions. But for now, it’s a good idea to get familiar with the exam itself.

The MBLEx was created and is managed by the Federation of State Massage Therapy Boards. You’ll hear it called the FSMTB for short.

If you’re curious, you can always look at the MBLEx official Candidate Handbook for more details. But, for now, we’ll walk you through the most important things you need to know.

For starters, the FSMTB offers the MBLEx in both English and Spanish. You’ll be able to choose your exam language when you fill out your application. Just keep in mind that some states have specific rules about which language you can test in. After you take the exam, your chosen language will be listed on the score report that gets sent to your state’s licensing board. So before you make your selection, be sure to check your state’s requirements.

Registration Process

To sign up for the exam, the first thing you’ll need to do is create an FSMTB Examination Account online. Once you’ve logged in, you’ll complete the application and pay the $265 fee using a Visa or Mastercard. After that, the next step is getting your education reviewed.

If you complete massage school in the United States, your school has to verify your education through something called the Education Verification Center, or EVC. This is an online portal that massage therapy schools use to access the FSMTB system and confirm that their students or graduates have completed the required training. So, after you list your school on your MBLEx application, someone at the school will automatically get a notification to verify your education.

However, if you studied massage therapy outside the United States, there are a few extra steps before you can sit for the MBLEx. First, it’s smart to directly communicate with the licensing board in the state where you hope to work to ask if they’re likely to accept your foreign education.

If the state licensing board says they’re most likely going to approve of your schooling, you’ll then need to have your education officially evaluated by a credential evaluation company like we mentioned earlier and the evaluation must be in English. Once you have your credential evaluation report, it should be sent directly to your state’s licensing board.

Then, if your state board decides your education meets their requirements, they will communicate their approval to the FSMTB. After that, the FSMTB should allow you to take the MBLEx. All in all, it’s important to remember that if you were educated internationally, the FSMTB relies on the state’s decision before allowing you to move forward with the MBLEx.

Having said that, let’s move on.

When your education is verified and your application is complete, the FSMTB will review your information and if everything looks correct, they will email you an Authorization to Test, also called an ATT.

This document gives you permission to schedule your exam. You will also be able to find your ATT by logging into your FSMTB Exam Account.

Your ATT will include a date range, and you need to take the exam before the expiration date listed or else your ATT will expire, and you will need to restart the application process.

When you receive your ATT, you will then schedule your exam through an independent company called Pearson VUE, which the FSMTB has partnered with to administer the MBLEx.

To create a Pearson VUE account, you’ll first find their online portal and click ”Create an Account,” then enter your FSMTB Candidate ID so your Pearson VUE and FSMTB accounts will be linked.

The exam is offered year-round at Pearson VUE testing centers across the United States, and to schedule your exam, you can either use the online Pearson VUE scheduler or call their phone number. After scheduling, Pearson VUE will send you a confirmation email with the details of your appointment.

Exam Content Breakdown

Now, let’s talk about what to expect on exam day.

The MBLEx is taken on a computer and consists of 100 multiple-choice questions that each offer three or four answer options. You’ll have 110 minutes to answer them, but your appointment is scheduled for a full two hours to give you a little extra time.

The exam uses a format called Computer Adaptive Testing, which means each question must be answered in the order they’re presented, and you cannot skip questions. As you answer questions correctly, the next ones become a little more challenging. If you miss one, the next question will be a bit easier. The exam adjusts to your ability level as you go, but to pass, you still need to answer enough questions correctly to meet the passing standard.

The exam covers seven different subject areas, which are broken down by percentage in the MBLEx content outline. Anatomy and physiology make up 11 percent of the questions. Kinesiology is 12 percent. Pathology, contraindications, areas of caution, and special populations make up 14 percent. Benefits and effects of soft tissue manipulation account for 15 percent. Client assessment, reassessment, and treatment planning are the largest section at 17 percent. Ethics, boundaries, laws, and regulations make up 16 percent. Finally, guidelines for professional practice make up 15 percent.

Scoring, Retakes, and Study Tools

Once you finish the exam, you’ll receive your unofficial results right there at the test center, which will simply say either pass or fail.

Then, an official copy of your results will be sent electronically to the state board or agency you listed on your application. This process usually happens within five business days, and if you pass, you should be eligible to apply for a license in that state.

If you need to retake the MBLEx, you’ll have to wait 30 days from your last exam date before testing again, and to retake the exam, you’ll need to submit a new application and pay another fee of $265.

Online Study Communities

But there are plenty of study tools that can help you prepare for the MBLEx and, hopefully, avoid taking the exam more than once.

One of the best places to start is with the official MBLEx Study Guide. It’s made by the same people who created the exam, the FSMTB, and it’s available in two versions, digital and printed.

The digital one is called the e-Study Guide. It’s easy to use, has the same content as the printed version, and is available in English and Spanish. It costs $35, and you’ll have access to it for one year from the date of purchase, with any updates released during that time also included.

If you prefer a physical book, there’s also a printed version. It has the same content as the digital one, just in a paper format. This version is only available in English and costs $39.95, including shipping.

Both versions include a comprehensive breakdown of the topics covered on the exam, helpful tips for test day, and a 100-question practice test to help you get a feel for the real thing.

The FSMTB has also designed a practice exam, which you can take online, called the MBLEx Check. The practice exam consists of 100 questions and covers each of the major topic areas in the actual test. It’s designed to feel as close to the real exam experience as possible, so you’ll know what to expect on test day. Like the digital study guide, the MBLEx Check is available in both English and Spanish and costs $25.

Another helpful resource you can use for free is a series of YouTube video lessons taught by a professional massage therapist named Jodi Scholes, who’s been teaching both in college and online since 1994. Jodi has over 250 videos focused on helping students prepare for the MBLEx, making her YouTube channel definitely worth checking out. A great video to start with is called Navigating the Body – Start here if you’re studying for the MBLEx, but really, her whole channel is packed with helpful content.

If you’re open to spending a little money for extra study help, you might want to check out an online program called ABMP Exam Coach. It offers over 2,000 massage terms with definitions and audio guides to help with pronunciation, more than 6,000 flashcards, and 5,000 quiz questions that shuffle each time, ensuring your practice stays fresh.

The program costs $25 for a six-month subscription, and you can use it on your phone, tablet, or computer, which makes it easy to study anywhere you have internet. Plus, it gives you feedback on what you’re doing well and where you need to improve.

Beyond study resources, you might find yourself wanting to connect with other people who are studying for the MBLEx. If that’s the case, there’s a Facebook group called MBLEx Test Prep Study Group with over 5,000 members. People post in the group every day, so you’ll likely get answers to your questions from others who are getting ready for the exam or who have already taken it.

Similarly, there’s a subreddit called “r/MassageTherapists” with over 22,000 members and multiple new posts every day. While the group isn’t focused only on the MBLEx, many of its members have taken the exam and are happy to share their experience. So, there’s a good chance you’ll find answers to your questions quickly. Another upside to joining spaces like this subreddit or the Facebook group is that even after you pass the MBLEx, you’ll still have a place to connect and talk about your career.

Licensing Requirements by State

While the national exam is required throughout most of the US, some states have extra licensing steps or state-specific exams you’ll need to pass.

So let’s go over the requirements in seven of the most popular states where immigrants often move. Most states ask for at least 500 hours of massage training, but the exact number of hours, steps, and types of documents can vary. And even if your state isn’t on this list, the process is usually similar, so this should still give you a good idea of what to expect.

California

For instance, in California, the California Massage Therapy Council, also known as CAMTC, does not require you to take the MBLEx. Still, many cities and counties may ask for CAMTC certification before you can start working. If you did your training outside the United States, your education might still qualify if it meets California’s standards. You’ll need to submit transcripts showing at least 500 hours of massage training, including 100 hours in areas like anatomy, ethics, and hygiene. The certification lasts two years and costs $300. While the certification is technically optional, having it can make things simpler since it lets you work in most places across the state without needing extra local permits.

Florida

In Florida, the first step to getting licensed is to have your foreign education evaluated. Florida requires a therapy course of at least 500 clock hours, so you’ll need to show that your training meets that standard. Then, you’ll need to show that you’ve passed the MBLEx, go through a background screening, and pay the $155 application fee.

Another requirement is to complete a ten-hour Florida Laws and Rules course. This course must be taken through an approved education provider if it was not already integrated into your massage school. It’s also worth noting that in Florida, candidates can take both the BCETMB and the MBLEx.

Illinois

As for Illinois, the state requires massage therapists to complete at least 600 hours of hands-on instruction. If you did your training outside the U.S., you’ll need to submit your transcripts along with a certified English translation. For foreign-trained applicants, online applications are not accepted, so they’ll need to call the state licensing board to request a paper application. The application fee is $175, and you’ll also need to have your fingerprints taken.

After your documents are submitted, the Massage Therapy Board will review your education to decide if you’re eligible to take the MBLEx. It’s important to note that your transcripts must be sent directly from your school, and you can’t send them yourself. After all that’s taken care of, if the board approves your education, you’ll then need to pass the MBLEx.

Massachusetts

In Massachusetts, massage therapists need to complete at least 650 hours of massage therapy education. When applying, you must send your official transcript to the Massachusetts Board of Registration of Massage Therapy in a sealed envelope along with a 2×2 inch passport-style photo. You’ll also need two signed reference letters: one from an employer in the massage field and another letter from a non-relative who can attest to your integrity. You’ll also need to provide proof of passing the MBLEx and a copy of your insurance policy. The application fee is $225, and everything must be submitted through the state’s online ePlace portal.

New Jersey

Massage therapists in New Jersey will need to complete at least 600 hours of massage therapy education and pass either the MBLEx or the BCETMB. You’ll also need to pay the $195 application fee.

When applying, you need to submit a completed Criminal History Certification of Authorization form, along with proof that you carry professional liability insurance. Your policy must cover at least $1,000,000 per occurrence and $3,000,000 total per year.

New York

New York has specific pathways for massage therapists trained outside the U.S. If you’ve been licensed and practicing in another country for at least two years, you may qualify for a New York license through something called “licensure by endorsement.”

To apply, you must be at least 21, submit your application and $108 fee, prove you’re a U.S. permanent resident or citizen, and show that you’ve passed a written licensing exam in your home country. If you’ve practiced massage therapy for 2 to 4 years, you’ll need to meet New York’s 1,000-hour education requirement and provide proof of your professional experience. If you’ve practiced for 5 years or more, you may qualify with 800 hours of classroom instruction. In exchange for needing fewer classroom hours, you’ll also need to show a certificate from a massage program that included at least 500 hours of training. This helps the state confirm that your experience is supported by formal education. You’ll also need to show you’ve kept up CPR certification within the past three years.

If your massage training took place in a country where English isn’t the primary language, you’ll need to show you can communicate in English. You can do this in a few ways like submitting a passing TOEFL score, showing you passed a licensing exam in English, providing scores from an English test taken for immigration or licensing, submitting a General Education Development certificate, also known as a GED, or proving you took college-level courses in English or the humanities. Then, the state board will review your exam and experience to decide if it meets New York’s standards.

If you’re not eligible to apply through endorsement, you may need to take the New York State Massage Therapy Exam which consists of 140 questions. To see what’s covered, check out the online exam blueprint that maps out the content areas and how the test is structured.

Texas

Finally, The Texas Department of Licensing and Regulation offers a clear path for massage therapists who trained outside the United States by reviewing each applicant’s credentials on a case by case basis.

To start the process, you’ll need to submit official certified transcripts of your coursework along with course descriptions from your massage school. You also have to show that your education consisted of at least 500 hours of massage training.

Next, you’ll need to pass the MBLEx, as well as the Texas Massage Jurisprudence Exam. This second exam covers the rules and laws you’ll follow while working in Texas, and it costs $34.

You’ll also need to request a license verification letter from the agency that issued your original license. This letter should include your full name, your license number, and the date it was first issued.

Once you’ve gathered all your documents, you can submit your application and pay the $100 application fee. Then you’ll need to complete a fingerprint background check to finish the process.

License Renewal by State

After you’re granted your massage therapy license, you’ll need to maintain it every two or three years to keep it active.

Most states require you to complete some continuing education hours and pay a fee when it is time to renew your license. The number of hours, the amount of the fee, and other steps can vary from state to state, but the process is generally similar across the country. So let’s look at the same seven states we discussed earlier. Even if you do not live in one of them, this overview should still help you understand what to expect when it is time to renew your license.

CE Hours and Fees in Key States

California

For starters, in California, to renew your CAMTC certificate, which we mentioned earlier, you’ll need to apply for recertification every 2 years and pay a $300 fee. There are no continuing education requirements, so as long as you submit your paperwork and payment on time, you’re all set.

Florida

Massage therapists in Florida need to complete 24 hours of continuing education every 2 years through the state’s official continuing education provider. When it’s time to renew your license, you’ll also need to pay a renewal fee of $105 to keep your license active.

Illinois

In Illinois, massage therapists renew their licenses every 2 years as well for a fee of $175. You’ll need to complete 25 hours of continuing education, including at least 2 hours of ethics.

Massachusetts

As for Massachusetts, massage therapists need to renew their license every 2 years by paying a $150 fee and completing 20 hours of continuing education. These courses must be approved by the NCBTMB or offered by a provider approved by the Massachusetts Board of Registration of Massage Therapy.

New Jersey

To maintain your massage therapy license in New Jersey, you’ll need to renew every 2 years with a $120 fee. During each renewal period, therapists must complete 20 hours of continuing education.

New York

In New York, the licensing period is a bit different at 3 years. And as such, the continuing education requirement is slightly greater at 36 hours. You’ll need to complete those hours during each 3-year registration period, and the renewal fee is $103.

Texas

Lastly, in Texas, massage therapists need to complete 12 hours of approved continuing education to renew their license. The license is valid for 2 years, and the renewal fee is $75.

Final Thoughts

That brings us to the end of our look at the massage therapy license renewal process in some of the most popular states for newcomers in the United States. Many other states follow similar rules, so what we have covered should give you a good idea of what to expect no matter where you plan to live.

As you prepare to move to the United States, you’ll find that massage therapists are needed in many places across the country, which can mean steady work and room to grow. The licensing process may take time and effort, but it opens the door to a career that makes a real difference in people’s lives. With your skills and experience, help others feel their best, find new opportunities to grow in this profession, and enjoy a financially rewarding career.

Also, remember that when you move to the United States, you will likely need certified translations of important documents such as your diploma, transcripts, and previous massage therapy credentials. If you need help with translations or have questions about the process, feel free to reach out to us. We want to support you as you start your new path in this rewarding profession.

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Author: Aaron Randolph | LinkedIn