Does Medicare Cover Acupuncture?
Medicare covers acupuncture for chronic low back pain. Read our guide and find out if you can get your treatment covered by Medicare.
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Key Takeaways:
Beginning in 2020, Medicare will cover acupuncture therapy for chronic lower back pain.
Coverage includes up to 12 visits in 90 days; if condition improves, up to eight more visits for the year will be covered.
Medicare Part B does not cover acupuncture for conditions other than chronic lower back pain.
Some Medicare Advantage plans may offer additional acupuncture coverage.
Until recently, as a Medicare beneficiary, you would have been left to pay for acupuncture out of your own pocket.
In January 2020, however, the Centers for Medicare and Medicaid Services (CMS) announced that Medicare would begin covering acupuncture therapy in certain circumstances — a welcome change for many seniors who rely on alternative therapies.
If you're wondering whether acupuncture is a therapeutic option you should pursue, we can help you determine if Medicare will pay for you to receive this service and how acupuncture therapy may be beneficial for you.
When is Acupuncture Covered by Medicare?
Medicare Part B will cover acupuncture therapy if you have been diagnosed with chronic low back pain. Your condition may qualify as chronic low back pain if:
You have lower back pain that lasts 12 weeks or longer
Have no known cause for this pain (pain is not caused by metastatic, inflammatory or infectious diseases)
Your pain is not associated with pregnancy or surgery
How Long Will Medicare Pay for Acupuncture?
Medicare initially covers up to 12 acupuncture sessions within a 90-day period. Your doctor must then evaluate whether your condition has shown improvement. If you are improving, Medicare will pay for eight more sessions for the year. Members may receive a maximum of 20 acupuncture sessions covered per year.
If you did not experience improvement in your chronic low back pain during the first 90 days of therapy, Medicare will not pay for additional acupuncture sessions.
Medicare coverage of acupuncture for low back pain
Does Medicare Cover Acupuncture for Other Conditions Besides Low Back Pain?
Chronic low back pain is the only condition covered under Medicare Part B. Acupuncture therapy used for any other indication will not be covered, and you will be responsible for the total cost of treatment.
What Other Medicare Coverage Options Do You Have?
If you choose a Medicare Advantage plan in place of Original Medicare (Medicare Part A plus Medicare Part B), a Medicare Advantage plan (also known as Part C) could include more expansive acupuncture services.
All Medicare Advantage plans are required at a minimum to cover the services offered by Original Medicare. In this case, that would mean all Advantage plans are required to cover the 12 acupuncture sessions for chronic low back pain with the potential of up to 20 sessions per year.
Most Advantage plans offer additional benefits outside of what is available through Original Medicare, so some Advantage plans may include coverage for acupuncture for other conditions or additional sessions.
While you probably don't want to choose an Advantage plan based solely on whether it covers acupuncture, this benefit may be a bonus in the plan that you do choose. If you already have an Advantage plan, be sure you check to see if acupuncture is covered; you may have the coverage and not even know it.
Are There Any Restrictions When Medicare Pays for Acupuncture?
We already discussed some of the restrictions to keep in mind when seeking Medicare coverage of acupuncture therapy:
You must have chronic low back pain
Your condition must show improvement to continue to receive therapy
You will get a maximum of 20 visits per year
There is another thing to know, however, when seeking acupuncture paid for by Medicare.
In order for your therapy to be covered, your acupuncture must be provided by a doctor (or another healthcare provider such as a nurse practitioner or physician assistant) who meets the following requirements.
Your provider must hold:
A master's or doctorate degree in acupuncture or Oriental Medicine from an accredited school AND a current license to practice acupuncture in your state
Why Should You Seek Acupuncture Therapy?
Acupuncture is derived from ancient Chinese tradition and involves insertion of tiny needles into strategic places of the body in an effort to relieve pain, promote wellness or manage stress.
There is increasingly convincing evidence to show that acupuncture can be effective in relieving chronic pain in various parts of the body such as the neck, lower back, knees or shoulders.
This is an especially important consideration in light of the current opioid epidemic. We know that using opiate-type medications to treat pain can cause serious harm. However, there is no significant downside to acupuncture. For those reasons, acupuncture is becoming an important tool for safe and effective chronic pain relief.
Other common uses for acupuncture include nausea, migraines, depression, and anxiety, just to name a few. Scientific researchers are still working to understand the benefits in a variety of disease states and to uncover the exact mechanism by which acupuncture exerts its effects on the body.
Over time, it is likely we will see more evidence to support the use of acupuncture for other conditions, and hopefully along with it we'll see more expansive coverage by Medicare and other health insurance companies.
Courtney Schmidt is a medical communications professional and clinical pharmacist with pediatric and adult hospital experience.
