Is Acupuncture Covered by Medicare
Is acupuncture covered by Medicare? Only if you have chronic low back pain as defined by Medicare.
Let’s look at what that means and what treatments are available.
This article is part of our series “What Does Medicare Cover?” Click the link to read about more frequently asked coverage questions in that article.
Medicare Acupuncture Coverage for Lower Back Pain
If you have chronic lower back pain, Medicare will cover a certain amount of acupuncture visits for you. It is covered under Medicare Part B.
What is considered “Chronic Lower Back Pain?”
According to the CMS, chronic lower back pain is defined as
– Lasting 12 weeks or longer
– Having no known cause (not related to cancer that has spread, inflammatory, or infectious disease)
– Pain not associated with surgery or pregnancyhttps://www.medicare.gov/coverage/acupuncture
What is Acupuncture?
Acupuncture is a healing technique first introduced by ancient Chinese Medicine. According to the U.S. Department of Health and Human Services’ National Center for Complementary and Integrative Health,
“Acupuncture is a technique in which practitioners stimulate specific points on the body—most often by inserting thin needles through the skin.”
According to the NIH, researchers have completed enough studies to conclude that acupuncture can be helpful to treat chronic back pain. Scientists need to complete more research on how acupuncture can benefit other conditions before Medicare will consider extending coverages.
How Many Acupuncture Sessions are Covered by Medicare?
If you are diagnosed with chronic lower back pain, you can receive up to 12 acupuncture visits in 90 days under Medicare Part B.
What Does Acupuncture Cost with Medicare?
Remember, there are still costs involved with Original Medicare under Part B.
- If you only have Original Medicare, then you will be responsible for a Part B co-insurance of 20%.
- Medicare pays 80% of the cost of services.
Medicare Co-Insurance Coverage Options
For the 20% you are responsible for, you can either:
- First, cover the cost of the co-insurance yourself “out-of-pocket”.
- Or, if you have a Supplement (Medigap) Plan, then your plan might pick up the rest. This depends on what letter plan you have purchased. The most popular plans pick up the entire co-insurance. These include:
- Finally, if you have a Medicare Advantage (MA/MAPD) Plan, then your plan may include benefits for acupuncture visits.
- MA/MAPD plans all structure their benefits differently. However, they are all required to provide AT LEAST what Original Medicare covers.
- Some may pay for a certain amount of visits or have co-pays for each visit.
If any of this is confusing to you, please see our article on How to Choose a Medicare Plan for help.
Where Can you Get Acupuncture Covered by Medicare?
Medicare will only cover an acupuncture treatment at select facilities with certain providers. (You can’t just go to any person advertising needle services.)
According to Medicare.gov,
Acupuncture must be given by a doctor, or by another health care provider (like a nurse practitioner or physician assistant) who has both of these:
– A masters or doctoral level degree in acupuncture or Oriental Medicine from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine
– A current, full, active, and unrestricted license to practice acupuncture in the state where care is being providedhttps://www.medicare.gov/coverage/acupuncture
There are programs on acupuncture created specifically for doctors and medical providers. If you want Medicare to cover your visit, you will need to find one of these trained providers that actively accept Medicare. (In addition, if you are on a Medicare Advantage Plan, make sure your provider is a part of your network.)
At this time, coverage of acupuncture treatments by Medicare is limited to chronic lower back pain.
If you are looking for Medicare covered treatment for back pain, make sure you find a medical provider that is properly trained and accepts Medicare as payment.
Your full cost for the service will depend on what supplemental Medicare plans you also have in addition to Medicare Part B.