According to the Centers for Medicare & Medicaid Services, Medicare Part B provides coverage for acupuncture treatment exclusively for chronic low back pain, with a maximum of 20 sessions covered per year.
To ensure that your treatment is eligible for payment, you’ll need to locate a provider who holds a current and unrestricted license to practice acupuncture and a master’s or doctoral degree in acupuncture from a school accredited by the Accreditation Commission for Acupuncture and Herbal Medicine.
If you don’t use a qualified practitioner, Medicare may refuse coverage for your acupuncture sessions with other health care provider.
What Is Acupuncture?
Acupuncture is a form of alternative, oriental medicine that involves the insertion of thin needles into specific points on the body.
It’s a key component of traditional Chinese medicine and has been used for thousands of years to treat and relieve pain from many health conditions.
The practice is based on the idea that the body has channels of energy called meridians, and that inserting needles into specific points on these meridians can stimulate the flow of energy and promote healing.
What Are The Benefits of Acupuncture?
Acupuncture can be effective in treating a few different health conditions:
• Pain management. Back pain (acupuncture for chronic low back pain), neck pain, knee pain, and joint pain.
• Anxiety and depression by promoting relaxation and reducing stress.
• Insomnia by improving sleep quality and duration.
• Digestive disorders, such as irritable bowel syndrome (IBS) and acid reflux.
• Headaches and migraines by reducing their frequency and intensity.
• Respiratory problems for people with asthma and other respiratory problems.
• Menstrual cramps and other gynecological conditions.
When Does Medicare Cover Acupuncture?
According to the Centers for Medicare & Medicaid Services, as of January 2020, Medicare began covering acupuncture as a treatment for chronic low back pain relief.
However, for acupuncture coverage, there are certain restrictions on the number of sessions and the type of healthcare provider who can practice acupuncture and administer the treatment.
Is Acupuncture Only Covered by Medicare for Chronic Low Back Pain?
Yes. According to the official government source on Medicare, Medicare.gov, acupuncture coverage is only for chronic back pain, as of right now.
What Is Considered Chronic Low Back Pain for Acupuncture Treatments?
The definition of chronic pain is as follows:
• Lasting 12 weeks or longer
• Not related to an obvious, known cause or infectious disease
• Pain that isn’t connected to surgery or pregnancy
Why Doesn’t Medicare Pay for Acupuncture for Other Conditions?
Although some studies have suggested that acupuncture may be beneficial for treating various health conditions, the evidence supporting its effectiveness is somewhat inconsistent and ambiguous.
The efficacy of Acupuncture or oriental medicine remain debatable topics in the industry, especially for Medicare coverage.
While in the past, Medicare had contemplated providing coverage for acupuncture in cases of osteoarthritis, the organization ultimately determined that the evidence was inadequate.
In accordance with government regulations, the CMS declared that the procedure was “not reasonable and necessary.”
Will Medicare cover acupuncture treatment for other conditions in the future? Stay abreast of the latest Medicare news with us and we’ll keep you posted.
What Part of Medicare Covers Acupuncture Services?
Medicare Part B covers acupuncture for chronic lower back pain treatments for those who have Original Medicare. This coverage includes up to 12 acupuncture visits for chronic lower back pain within a 90-day period, with an additional eight sessions covered if your condition improves.
However, if the patient’s condition does not improve or worsens, Medicare will not cover your additional treatments and they should be discontinued.
The maximum number of acupuncture treatments covered by Medicare per year is 20.
The Cost of Acupuncture Treatments with Medicare
Once the annual Part B deductible has been met, you will pay 20% of the Medicare-approved amount.
Do Medigap Plans Cover Acupuncture?
Depending on the policy, Medigap plans can cover some or all of your coinsurance payments when you receive acupuncture treatments.
For example, Plan K covers only 50% of your expenses, while Plan L covers 75%. All other Medigap plans cover your entire coinsurance payment, with the exception of Plan N, which charges a maximum $20 copayment instead of coinsurance.
Remember, if Medicare denies your claim, Medigap will not cover any portion of the cost and you will need to pay the full amount.
Does Medicare Advantage Cover Acupuncture?
Yes, all Medicare Advantage plans cover acupuncture for chronic low back pain as it’s required by Medicare.
With some Medicare Advantage plans you may need preauthorization for acupuncture or a referral by your family doctor.
With an HMO Medicare Advantage plan, you may need to use an in-network acupuncturist or seek special approval for out-of-network care.
Which Providers of Acupuncture Treatments Are Covered by Medicare?
Medicare coverage for acupuncture for chronic low back pain is not automatically extended to licensed acupuncturists because the Centers for Medicare & Medicaid Services (CMS) do not recognize them as Medicare providers.
Instead, Medicare requires that the treatment is administered by a doctor or healthcare provider with specific qualifications, not just someone who practices acupuncture or oriental medicine.
These qualifications, according to CMS, include
• holding a master’s or doctoral level degree in acupuncture from a school accredited by an Accreditation Commission for Acupuncture and Herbal Medicine (ACAHM)
• possessing an active and unrestricted license to practice acupuncture in a state, territory, or commonwealth of the U.S. (including the District of Columbia)
• either being a Medicare provider or being supervised by one.
Does Acupuncture Actually Work?
Acupuncture research is controversial. There are different opinions on oriental medicine and other nontraditional medical treatments.
There have been some studies suggesting that acupuncture can be effective in treating certain conditions, such as chronic lower back pain, migraines, and nausea.
The other studies have been inconclusive or have suggested that the effects of acupuncture are primarily due to placebo.
Individual experiences with acupuncture for chronic low back pain and other conditions may vary, and some people may find it to be a helpful complementary therapy for their condition, while others may not experience any real benefits.
Contact Us Today!
Don’t hesitate to reach out to us if you have any more questions like, does Medicare cover acupuncture, physical therapy or any other Medicare-related concerns.
We are here to represent your best interest and help you make an informed decision!
If you are looking for more education on Medicare, try our article on what Medicare covers.