Does Medicare Cover Acupuncture?

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Does Medicare Cover Acupuncture?

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Does Medicare cover acupuncture treatments? Yes!

On January 21, 2020, the Centers for Medicare & Medicaid Services (CMS) gave notice that acupuncture treatments will be covered to help with chronic low back pain. This is great news for anyone who suffers from chronic low back pain and is looking for an alternative medication painkillers.

In this article we’ll discuss:

Does Medicare cover acupuncture?

More specifically, “Does Medicare Part B cover acupuncture?” Your Medicare Part B will cover up to 12 acupuncture visits within 90 days if you have chronic low back pain.

Chronic lower back pain is described as:

  • Low back pain lasting 12 weeks or more
  • Having an unknown cause (For example, not associated with an infectious, metastatic or inflammatory disease)
  • Lower back pain that is not due to or associated with pregnancy or surgery

Can I get more than 12 acupuncture visits?

You can receive an extra 8 sessions if you show improvement from your acupuncture treatment. If your physician determines that your lower back pain is getting worse or is not improving, then Medicare will not cover additional treatments.

You can not receive more than 20 acupuncture treatments for your lower back pain each year.

How will Medicare approve my acupuncture treatment?

Your acupuncture treatments must be provided by a health care provider. This may include a doctor, physician assistant or nurse practitioner who meets the following criteria:

  • Health care provider with a doctorate or masters level degree in Oriental Medicine or acupuncture from an accredited school by the Accreditation Commission on Acupuncture and Oriental Medicine
  • A health care provider with an active, unrestricted, full, and current license to practice acupuncture in the state where treatment will be provided

Do Medicare Supplement plans pay for acupuncture?

Yes!

Your Medicare Supplement will pay for any benefit that Medicare covers. Medicare typically pays for 80% of Medicare approved costs and the remaining 20% is up to the insured to pay. If you have a Medigap plan, then your plan can pay for the remaining 20%. 

When Medicare approves your acupuncture treatment, then your Medicare Supplement company will pay their portion of the bill according to your plan. However, if Medicare denies coverage for any treatment, Medigap plans won’t pay either.

How much does acupuncture cost?

According to CostHelper, acupuncture costs will range somewhere between $75 – $95 for an initial acupuncture session. Routine visits will cost between $50 to $70. Treatment costs varies from practitioner to practitioner, so you will need to contact acupuncturists in your area for specific prices.

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