After a spell as a player in the fifth division in Switzerland's canton of Ticino, Massimo Busacca opted for a career as a referee in 1990, making his debut in the Swiss first division in 1996.

His international breakthrough came three years later, when he took charge of his first tie in the 1999 UEFA Intertoto Cup. His first fixture between national sides was the 2001 Northern Ireland-Bulgaria FIFA World Cup™ qualifier.

Since then, he has been one of the busiest referees in European club-level competitions, officiating in a UEFA Cup semi-final in 2005 and then the 2007 Espanyol-Sevilla final, as well as the 2008 UEFA Champions League semi-final between Barcelona and Manchester United.

He shares the honour for the most appearances at the FIFA U-20 World Cup with Benito Archundia and Oscar Ruiz, with a total of nine matches in 2003 and 2005.

Over the years, Busacca, who speaks five languages, has developed extensive international experience, officiating in important league matches overseas, including Saudi Arabia, Australia, Egypt, Lebanon, Qatar, Romania and Russia. In addition, he handed the delicate task of presiding over the Uzbekistan-Bahrain qualifier for the 2006 FIFA World Cup Germany™.
He was involved in the finals of Germany 2006 up to the Round of 16, overseeing three matches.

He also took part in UEFA EURO 2008 and presided over the Germany v. Turkey semi-final.

Away from the football field, his personal best in the 800 metres is 2:02 and he was Switzerland's "Non-Smoker of the Year" for 2006.