In 2020, Medicare began to cover acupuncture in an effort to decrease the number of people turning towards prescription opioids for pain relief. 

However, coverage under Medicare Part B is extremely limited. Those wishing to have acupuncture covered under their Medicare Part B plan must adhere to specific circumstances and only have limited visits each year. Plus, the number of treatments you will receive will depend on your health’s improvement. 

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What Is Acupuncture?

Acupuncture involves the insertion of thin needles into your skin at specific points to stimulate nerves and release tension.

Acupuncture finds its roots in traditional Chinese medicine, where it is used as “a method for balancing the flow of energy or life force — known as chi or qi (chee) — believed to flow through pathways (meridians) in your body.” (source)

In contrast, many Western practitioners view acupuncture points as places to stimulate nerves and muscle. Some believe this stimulation boosts your body’s natural painkillers so you can feel relief without prescription medication or even chiropractic adjustments. In the United States, it is currently used to relieve stress and help with overall wellness and pain management.

In America, acupuncture is used to relieve discomfort associated with ailments such as: 

  • Chemotherapy-induced and postoperative nausea and vomiting
  • Dental pain
  • Headaches, including tension headaches and migraines
  • Labor pain
  • Low back pain
  • Neck pain
  • Osteoarthritis
  • Menstrual cramps
  • Respiratory disorders, such as allergic rhinitis

(source)

Is Acupuncture Covered by Medicare?

Currently, Medicare Part B will cover acupuncture (including dry needling) only for chronic lower back pain. Medicare defines this as: 

  • Lower back pain lasting 12 weeks or longer
  • The pain is unrelated to known cancers, inflammation, or any infectious diseases
  • The pain is not associated with surgery or pregnancy

Furthermore, Medicare.gov outlines that Medicare beneficiaries must get acupuncture from a doctor or by another healthcare provider (a physician assistant or a nurse practitioner) who has:

  • 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 provided

Which Acupuncture Treatments Are Excluded from Coverage?

While acupuncture can be a beneficial tool for pain and stress management, Medicare will not cover it to treat discomfort in other parts of the body, such as neck pain, headaches, stress, or relief from chemo. It also doesn’t cover temporary acute conditions linked to injuries or pregnancy-related lower back discomfort. 

What Parts of Medicare Cover Acupuncture?

Many people try to get acupuncture covered by Medicare because of the relief it provides. However, this treatment falls outside of what is considered traditional medicine and is still considered naturopathic care. But, in 2020, Medicare decided to begin limited coverage of acupuncture for chronic lower back pain. 

“We are dedicated to increasing access to alternatives to prescription opioids and believe that covering acupuncture for chronic low back pain is in the best interest of Medicare patients,” said CMS Principal Deputy Administrator of Operations and Policy Kimberly Brandt in a press release. “We are building on important lessons learned from the private sector in this critical aspect of patient care. Over-reliance on opioids for people with chronic pain is one of the factors that led to the crisis, so it is vital that we offer a range of treatment options for our beneficiaries.”

Currently, only Medicare Part B covers acupuncture for chronic lower back pain. 

Do Medicare Advantage Plans Cover Acupuncture?

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Medicare Advantage plans cover the same amount of care as Original Medicare. Medicare Part C covers acupuncture for chronic lower back pain under the same conditions outlined to receive coverage with Original Medicare Part B. 

Some Medicare Advantage plans may extend coverage to treat other conditions, but a deductible and copayment may apply. Carriers may offer this benefit, but it depends on the plans available in your service area. 

Medicare Advantage plans may only support work done by practitioners within a provider network. So once you know that acupuncture is covered, make sure your Part C plan’s guidelines about whose services are included within your area. 

Do Medicare Supplement Plans Cover Acupuncture?

As Medicare Supplement Plans cover the same benefits that Original Medicare covers, your Medigap company will pay a portion of the bill for approved acupuncture treatment.

How Long Will Medicare Cover Acupuncture?

Medicare will cover up to 12 visits in 90 days for eligible beneficiaries and cover an additional eight months for patients who have shown improvement, resulting in a maximum of 20 sessions per year. If you don’t see any improvement in your chronic low back pain after a 90-day period of acupuncture sessions, Medicare may refuse payment for additional treatments.

For more information, visit cms.gov to read the full NCA Decision Memo

What Are Your Options If Medicare Doesn’t Cover Acupuncture?

Thankfully, Medicare plans can work with other medical insurance when you’re enrolled in a Medicare Supplement plan. For example, an insurer could pay for services up to a set amount, and then the other insurer would cover the remaining cost. So, even if your Medicare plan will not cover your acupuncture treatment, you may have the ability to claim it on another insurance policy.

How to Get Medicare Coverage for Acupuncture

If you are looking for comprehensive coverage that includes Acupuncture, call Coverage Haven to discuss your options.

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