- As of January 21, 2020, Medicare Part B covers 12 acupuncture sessions within a 90 period to treat medically diagnosed chronic lower back pain.
- Acupuncture treatments must be performed by a qualified, licensed medical practitioner.
- Medicare Part B may cover up 20 acupuncture session per year.
Acupuncture is a holistic remedy that has been practiced for thousands of years. Medical literature indicates that, depending on the circumstances, acupuncture may be an effective treatment for acute and chronic pain.
In part as a response to the opioid crisis, on January 21, 2020, the Centers for Medicare & Medicaid Services (CMS) issued new rules regarding Medicare coverage for acupuncture treatment. Medicare now covers 12 acupuncture sessions per 90 day period for the treatment of lower back pain and as many as 20 acupuncture sessions per year.
As of January 2020, Medicare Part B covers acupuncture treatments for the treatment of lower back pain. These treatments must be conducted by a medical doctor or other qualified healthcare professional such as a nurse practitioner or physician assistant who has both these qualifications:
- a masters or doctoral level degree in acupuncture or Oriental Medicine from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine (ACAOM)
- a current, full, active, and unrestricted license to practice acupuncture in the state where care is being provided
Medicare Part B covers 12 acupuncture sessions in 90 days and up to 20 session per year. The additional 8 sessions may be covered if you are showing improvement during treatment.
You qualify for coverage for acupuncture treatment coverage if:
- You have a diagnosis of lower back pain that has lasted 12 weeks or longer.
- Your back pain has no identified systemic cause or is not associated with metastatic, inflammatory, or infectious disease.
- Your back pain is not associated with surgery or pregnancy.
Medicare only covers acupuncture treatment for medically diagnosed chronic low back pain.
Acupuncture costs can vary according to your provider and where you live. Your first appointment may be the most expensive, as you will need to pay for the consultation fee as well as any treatment.
Medicare has not yet issued the amount they will pay for acupuncture treatment. Once this approved fee has been established, if you have Medicare Part B, you will be responsible for 20 percent of that fee and your Part B deductible.
Without Medicare, you may expect to pay $100 or more for the initial treatment and between $50 and $75 for treatments after that. A
Because rates can vary, ask your practitioner how much your session will cost. Get an estimate in writing, if you can, before you agree to be treated by your chosen acupuncture provider. To be covered by Medicare, any acupuncture practitioner must meet Medicare requirements and agree to accept Medicare payment.
While Medicare doesn’t cover most alternative therapies, you may be covered for some alternative treatments under specific circumstances.
At this time, Medicare doesn’t cover massage therapy, even in instances when it’s prescribed by your doctor.
Medicare Part B covers adjustments to your spine performed by a chiropractor. If you have a diagnosis of a slipped bone in your spine, you may be eligible for medically necessary chiropractic treatments.
According to Medicare’s policies, you’ll still be responsible for 20 percent of the treatment’s cost, as well as your Medicare Part B yearly deductible.
Medicare does not cover other services a chiropractor might provide or prescribe, such as acupuncture and massage, and Medicare does not cover tests ordered by a chiropractor such as X-ray.
Medicare Part B covers medically necessary physical therapy treatments. These treatments must be performed by a physical therapist who participates in Medicare and prescribed by a doctor who submits documentation showing that you need the treatment.
You’ll still be responsible for 20 percent of the treatment cost, as well as your Medicare Part B yearly deductible.
Medicare Part C (Medicare Advantage) plans are private insurance plans that provide the benefits of original Medicare combined with options from private insurance companies. Advantage plans must cover services that Medicare Part B covers, so any Medicare Advantage plan must cover acupuncture at least the same as Medicare Part B.
Part C may deny claims for alternative treatments. If you have a Medicare Advantage plan, ask your provider their policy for other alternative medical treatments.
Medigap supplement plans can be purchased to increase the benefits of traditional Medicare coverage. These supplement plans cover things like deductibles and other out-of-pocket medical expenses.
Private insurance plans are the most likely to cover alternative therapies. While the initial cost of private insurance plans may be higher, these plans may reduce costs of alternative therapies.
Tips for navigating Medicare choices
Medicare can be confusing and hard to navigate. Whether you’re enrolling yourself or helping a loved one, here are some suggestions help during the process:
- Make a list of your medical conditions and all medications you take. Knowing your current medical needs will help when you search Medicare.gov or talk to the Social Security Administration.
- Search Medicare.gov for specific details on all Medicare plans. Medicare.gov has tools to help you search for coverage based on many factors, such as your age, location, income, and medical history.
- Contact the Social Security Administration for any questions. Medicare enrollment is managed by the Social Security Administration. Contact them before you enroll. You can call, look online, or schedule an in-person meeting.
- Take notes during any calls or meetings preparing for enrollment. These notes can help clarify information about healthcare and coverage.
- Make a budget. It’s important to know exactly how much you can afford to pay for your Medicare benefits.
Acupuncture may be an effective treatment for some health conditions that affect seniors, such as rheumatoid arthritis or chronic lower back pain.
Beginning January 21, 2020, Medicare Part B covers acupuncture treatment of chronic lower back pain for up to 12 sessions in 90 days and up to 20 sessions per year .
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