Medicare covers acupuncture treatments for chronic lower back pain. Medicare Part B initially covers twelve acupuncture visits in a 90 day period. Some Medicare Advantage plans may cover acupuncture sessions for other health conditions.
Key Takeaways
- Acupuncture may be prescribed as an alternative treatment for pain management instead of prescription drugs.
- Medicare Part B covers 12 to 20 acupuncture sessions for chronic low back pain, depending on the treatment’s effectiveness.
- Medicare beneficiaries must receive their acupuncture from a licensed acupuncturist to receive coverage for the service.
- The chronic low back pain must not be a symptom of another ailment and must have persisted for twelve weeks to be covered by Medicare.
- Some Medicare Advantage plans may cover acupuncture sessions for other conditions.
What Is Acupuncture?
Acupuncture refers to the insertion of very thin needles into the skin at precise points on the body to treat pain and stress. Traditional Chinese medicine views acupuncture as a method of balancing the flow of energy of the body by targeting specific acupuncture points. It is growing in popularity for its use in stress management and overall wellness.1Mayoclinic.org, “Acupuncture“, Accessed October 28, 2021
Western acupuncture practitioners regard it as a method of stimulating nerves, muscles, and connective tissue to generate the body’s natural painkillers. Health care providers may prescribe acupuncture treatment as non-pharmacological pain management. This means the beneficiary may be able to avoid treating their pain with an expensive opioid prescription with potential side effects.2CMS.gov, “Acupuncture for Chronic Low Back Pain“, Accessed November 2, 2021
How Does Medicare Cover Acupuncture?
Medicare Part B covers up to twelve acupuncture sessions in a 90 day period for chronic low back pain. Part B will also cover eight extra sessions if the beneficiary’s chronic back pain shows improvement. Medicare will not provide these extra sessions if the beneficiary’s doctor does not see an improvement. Medicare limits acupuncture sessions to 20 total within a twelve-month period.3Medicare.gov, “Acupuncture“, Accessed October 28, 2021
Medicare beneficiaries can only receive coverage for acupuncture performed by a health care provider with the following qualifications:3Medicare.gov, “Acupuncture“, Accessed October 28, 2021
- A master’s or doctoral-level degree in acupuncture or oriental medicine from a school that is accredited by the Accreditation Commission on Acupuncture and Oriental Medicine.
- A fully active and unrestricted acupuncturist license for the region and/or state the beneficiary is receiving acupuncture.
Chronic Low Back Pain
Medicare defines chronic low back pain as:3Medicare.gov, “Acupuncture“, Accessed October 28, 2021
- Lasting twelve weeks or longer
- Having no known cause (not related to cancer that has spread, inflammatory, or infectious disease)
- Pain not associated with surgery or pregnancy
How Much Does Acupuncture Cost?
Acupuncture treatments vary widely from area to area. The current range is between $85 and $125. However, it’s important to remember that Medicare Part B only pays 80 percent of the Medicare-approved amount. If your acupuncturist charges Excess Charges, you will pay those out-of-pocket unless you have a Medicare Advantage plan or a Medigap policy that covers Part B Excess Charges.
Medicare Advantage
Medicare Advantage plans are required to cover the same services as Medicare Part A and Part B, in addition to any expanded services offered. That includes acupuncture. However, a beneficiary’s out-of-pocket costs with a Medicare Advantage plan may be different than those with Original Medicare. Also, Medicare Advantage plan rules may require their members to use network providers for all services, supplies, and durable medical equipment.5Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed October 29, 2021
Medigap
People with Original Medicare can purchase additional insurance, called Medigap, to help cover their Medicare out-of-pocket costs. Medicare supplement insurance, as it is also known, is available through private insurance companies. A Medigap policy will cover some or all of the out-of-pocket costs associated with Medicare-approved acupuncture services. These costs include:6Medicare.gov, “What’s Medicare Supplement Insurance (Medigap)?“, Accessed October 29, 2021
- Deductibles
- Coinsurance
- Copayments
- Blood
How To Find a Licensed Acupuncturist
Medicare covers acupuncture treatment when performed by a licensed medical doctor or other health care provider such as a physician assistant or nurse practitioner. In addition to their license or certification, they must also have:
- A degree (masters or doctorate) in traditional Asian Medicine or acupuncture from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine.
- A license to practice acupuncture in the state where the treatments take place.
You can find a licensed acupuncturist meeting Medicare’s requirements in several ways:
- Check with your state acupuncturist regulating agency.
- Use the National Certification Commission for Acupuncture and Oriental Medicine Find a Practitioner tool.
- Contact your Medicare Advantage plan and ask for a list of in-network providers.
NOTE: Alabama, Oklahoma, and South Dakota do not regulate acupuncturists.
Summary
You now know if acupuncture is a Medicare-approved treatment. At least twelve acupuncture sessions can be covered by Medicare for chronic lower back pain, with the approval of your doctor. Medicare Advantage plans can also cover acupuncture for other ailments. Original Medicare and Medicare Advantage plans pay a share of the costs for the treatment. The type of coverage you have will affect your remaining out-of-pocket costs.
Citations
- 1Mayoclinic.org, “Acupuncture“, Accessed October 28, 2021
- 2CMS.gov, “Acupuncture for Chronic Low Back Pain“, Accessed November 2, 2021
- 3Medicare.gov, “Acupuncture“, Accessed October 28, 2021
- 5Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed October 29, 2021
- 6Medicare.gov, “What’s Medicare Supplement Insurance (Medigap)?“, Accessed October 29, 2021