Medicare covers acupuncture treatments for chronic lower back pain. Medicare Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. initially covers twelve acupuncture visits in a 90 day period. Some Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). may cover acupuncture sessions for other health conditions.
Key Takeaways
- Acupuncture is the traditional Chinese practice of stimulating key points on the body with thin needles to relieve pain and stress.
- 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.
- MedigapMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage. policies can provide additional help with costs after Medicare has provided coverage.
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 beneficiaryA person who has health care insurance through the Medicare or Medicaid programs. 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 providerA person or organization that’s licensed to give health care. Doctors, nurses, and hospitals are examples of health care providers. 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 amountA Medicare-approved amount is what Medicare will pay for a covered service. Healthcare providers that agree to Medicare assignment accept the approved amount without excess charges. What Does Medicare-Approved Amount Mean? A Medicare-approved amount is.... If your acupuncturist charges Excess ChargesA Medicare Part B excess charge is the difference between a health care provider’s actual charge and Medicare’s approved amount for payment., 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 AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. and Part B, in addition to any expanded services offered. That includes acupuncture. However, a beneficiary’s out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. with a Medicare Advantage plan may be different than those with Original MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage.. Also, Medicare Advantage plan rules may require their members to use network providers for all services, supplies, and durable medical equipmentDurable medical equipment (DME) is equipment that is designed to last and can be used repeatedly. It is suitable for home use and includes wheelchairs, oxygen equipment, and hospital beds..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
- DeductiblesA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share.
- CoinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service.Â
- CopaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service.
- 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-networkDoctors, hospitals, pharmacies, and other healthcare providers that agree to health plan members' services and supplies at a set price are in-network providers. With some health plans, your care is only covered if you get... 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