Acupuncture and Medicare

What is Acupuncture?

Acupuncture is a complementary medical practice that entails stimulating a point on the body with small, thin needles to relieve pain and restore energy flow. It is a practice used in traditional Chinese medicine.

Results from a number of studies suggest that acupuncture may help ease types of pain that are often chronic such as low-back pain, neck pain and osteoarthritis/knee pain. It may also help reduce the frequency of tension headaches and prevent migraine headaches. Therefore, acupuncture appears to be a reasonable option for people with chronic pain to consider. This process can trigger the release of pain-relieving chemicals that occur naturally in the body, according to an article in The Journal of Alternative and Complementary Medicine

Does Medicare Cover Acupuncture?

In 2020, Medicare began covering acupuncture as a treatment for lower back pain. At present, Medicare funds up to 12 sessions of acupuncture treatment for those with chronic lower back pain. The insured individual will need to pay 20% of the fee that Medicare approves, as Part B covers acupuncture, and coinsurance applies. (Unless you have a Medigap plan that pays a portion of the 20%)

A person must receive these 12 treatment sessions within a 90-day window. 

Coverage for further sessions is available for those with chronic pain whose symptoms improve after the first 12 sessions, with the possibility of an additional eight sessions. 

Medicare will only cover up to 20 sessions in a 12-month period, based on available research about the lasting effects of acupuncture treatments. 

For Medicare to cover acupuncture, the person administering it must be either:

  • A Doctor
  • A Physician’s Assistant
  • A Nurse Practitioner
  • A Healthcare professional with master’s or doctorate level training in acupuncture and a state license to practice acupuncture. 

Medicare has put improved acupuncture coverage in place as a part of a growing effort to help people access nonopioid pain management.

According to a press release announcing the decision to expand acupuncture coverage, the CMS reviewed several studies that supported the use of acupuncture in treating lower back pain. 

Does Medicare Advantage plans cover acupuncture?

Medicare Advantage is an alternative to traditional Medicare. An insured person pays a private insurance company for parts A, B, and D. This coverage includes hospital care, medical care and prescription drugs. 

Some people choose Medicare Advantage policies because these also cover additional services, such as dental or eye care. 

Medicare Advantage plans provide the same level of coverage as traditional Medicare, including the same procedures and medical treatments. Therefore Medicare Advantage will also cover acupuncture for lower back pain. 

However, some Medicare Advantage plans may expand acupuncture coverage to treat other conditions. A deductible and copayment may still apply. 

Many Medicare Advantage plans require a person to choose healthcare providers from within a limited network. This requirement may extend to acupuncture professionals. 

Other Medicare Advantage plans require a physician to refer a person to an acupuncture professional before Medicare covers the costs. 

People with a Medicare Advantage plan may wish to contact their insurance provider for a list of in-network healthcare professionals and clarification of their level of acupuncture coverage. 

According to a press release from CMS, “Expanding options for pain treatment is a key piece of the Trump Administrations’ strategy for defeating our country’s opioid crisis,” said HHS Secretary Alex Azar. “President Trump has promised to protect and improve Medicare for our seniors, and deciding to cover this new treatment option is another sign of that commitment. Medicare beneficiaries will now have a new option at their disposal to help them deal with chronic low back pain, which is a common and sometimes debilitating condition.”  

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