Is acupuncture covered under Medicare? How To Get Acupuncture Covered by Insurance

Back pain issues have reportedly increased to a significant number in the past few years. Besides, according to reports, 22%-48% of American adults are affected by back pain. If you are one of them and have been acquiring regular back pain treatments using your health coverage but haven’t gotten rid of them, you might need to look for other alternatives like acupuncture. But does Medicare cover acupuncture? This needs a thorough discussion.

In addition, acupuncture is not a new treatment or therapy. It brings a new hope within when people begin feeling changes and improvement in their back pain and ultimately in the quality of their lives. It is important to note here that not all insurers cover acupuncture. Luckily, Medicare Part B is the insurer we have that covers many sessions to treat severe lower-back pains.

If you have Medicare coverage and chronic back pain, here are a few things that you need to be aware of.

What is acupuncture?

A Chinese treatment called acupuncture is another name for needle penetration, an alternative back pain treatment. In the process, an acupuncturist inserts sharp tiny needles into your body’s specific and designated parts that stimulate your nervous system. Due to this Chinese technique, lower back pain sufferers have shown improved results in their lower back pain from the first session.

Is Acupuncture covered under Medicare?

What is acupuncture

Medicare is one of the insurers who cover acupuncture but to a significant level. Medicare covers only severe or intense lower back pain. Medicare has never been covering acupuncture from the very start. This policy change was made back in January 2020 when CMS announced its policy updates. This was one of the ways to address the opioid crisis which was associated with the over-prescription of opioids by doctors to patients suffering from pain.

Therefore, you can take 12 acupuncture sessions with the Medicare-approved acupuncturist within 90 days. Also, if the improvement occurs, you will be granted eight more sessions from Medicare part B coverage. This means that you can have twenty sessions throughout the year. On the other hand, if the condition worsens, Medicare might not approve more sessions.

Once you meet 2022’s Medicare part B deductibles of $233, Medicare’s acupuncture coverage comes in. Through this, Medicare coverage pays 80% of the whole amount, whereas the remaining 20% can be paid out of your pocket or through coverage offered by Medigap.

Medicare updated policies and guidelines are applied to all Medicare coverage along with Medicare Advantage plans (Medicare Part C). However, MA plans C provides all the original Medicare coverage benefits.

Some of the MA plans deal with expanded acupuncture coverage. This means coverages like UnitedHealthcare Medicare Advantage plans cover the treatments for symptoms that you might have due to acupuncture such as nausea. Additionally, coverage like CareFirst BlueCross BlueShield covers acupuncture sessions for a routine checkup in their Medicare Advantage plans.

However, every Medicare plan or insurance coverage is different. You can ask your insurer or your State Health Insurance Assistance Program (SHIP) will help you find the additional details regarding your coverage.

How does Medicare define severe back pain?

To consider back pain severe and cover it through Medicare, the CMS describes that it should;

  • Not related to any other chronic disease like cancer or diabetes.
  • Lasts more than or equal to three months
  • Unrelated to post-pregnancy or surgery

Who can perform acupuncture?

Acupuncture treatments taken by licensed acupuncturists cannot be covered through Medicare. This is because Medicare does not accept licensed acupuncturists as a provider. Instead, Medicare wants you to be treated for your back pain by a physician or healthcare provider with a range of certain qualifications. CMS requires doctors to be covered for acupuncture should;

  • Have a doctoral degree or master’s in acupuncture from an accredited school by ACAHM – Accreditation Commission for Acupuncture and Herbal Medicine.
  • Have an active, full, and unrestricted license in order to practice acupuncture in the state, the commonwealth of the US, and in the territory of the District of Columbia.
  • Working as a Medicare provider or have been supervised by a provider accepted by Medicare.
How does Medicare define severe back pain

How can acupuncture help patients?

Acupuncture has a wide history of providing relief to patients with chronic back pain and encouraging the body to heal the suffering itself. Acupuncture is one of the safest treatments for numerous health issues and diseases. It is effective in symptoms of a range of body pains from lower back pains to cancer treatment.

The National Institute of Health says, that acupuncture can be effective in relieving;

  • Neck pain
  • Back pain
  • Migraines
  • Osteoarthritis/Knee Pain
  • Stress
  • Seasonal allergies
  • Cancer-associated symptoms like vomiting and fatigue

Why doesn’t Medicare cover these conditions?

Although studies have found the effectiveness of acupuncture in many health conditions such as angina and migraines, reports say that effectiveness is unclear and sometimes becomes patchy.

For example; Medicare once considered osteoarthritis for insurance coverage but later they concluded that the effectiveness was insufficient. Then CMS announced a change in the policy stating that they don’t see that acupuncture treatment for osteoarthritis was not reasonably necessary as required by government regulation.

This translates to the fact that if you need acupuncture therapy other than chronic lower-back pain, you have to pay for the service out of your pocket. The next question that may arise includes what would be the cost for acupuncture other than back pain. One study on pricing revealed that the average cost of acupuncture treatment is $112 for the first session and gradually decreases such that it may become $80 for future visits.

However, the cost totally depends on the state and the location where you live. You can negotiate for a lower charge when you plan for further visits.

Bottom Line

Does Medicare cover acupuncture? From the above discussion, you might have gotten your answer. Medicare does cover acupuncture but for significant conditions and for a limit of twenty sessions a year. To get the coverage from Medicare, find a doctor with a range of qualifications that Medicare accepts as a provider so your treatment claims would not be denied.