Acupuncture is a technique used by many people to help with pain management and avoid the need to take opioid pain medication. It is based on traditional Chinese medicine techniques, and it involves inserting thin needles into the skin in various places. Many people are extremely happy with the results, although acupuncture treatments can sometimes be expensive. Some insurance plans cover acupuncture treatments, while others do not. If you are on a Medicare plan, you might wonder, “Does Medicare pay for acupuncture?” Keep reading as we give you all the details on Medicare and acupuncture.
Does Medicare Cover Acupuncture?
Yes, Medicare covers acupuncture, but only if certain conditions are met. As long as the acupuncture services meet the required conditions, then your Medicare Part B plan will cover the service. Here are the requirements established by the Centers for Medicare & Medicaid Services: First, acupuncture must be for the treatment of chronic low back pain. Acupuncture treatment for other conditions will not be covered by Medicare. Many people use acupuncture to treat neck pain and other types of pain. However, Medicare will only pay for acupuncture to treat chronic lower back pain. Next, a provider who meets Medicare requirements must perform the acupuncture service. We will discuss those requirements in more detail later in this article.
If the conditions above are met, then Medicare will pay for up to 12 acupuncture visits in 90 days. Additional visits might be covered if your condition is improving. If you are showing improvement, Medicare will pay for an additional eight acupuncture visits. This means that Medicare will pay for up to 20 visits during a 12-month period. However, if you show no signs of improvement after your first 12 visits, then Medicare will not pay for additional treatment.
Whether or not your condition is improving must be documented by your doctor. If your doctor determines that your condition is worsening or showing no signs of improvement, then you should discontinue the acupuncture treatments. If you decide to continue the treatments anyway, you will need to pay for them out of your own pocket or by using other health insurance. Medicare will not continue to pay for additional treatments if your condition is not improving.
It is also worth noting that Medicare does not currently cover dry needling techniques. While dry needling and acupuncture are very similar, the rules for each type of treatment are a little different. Dry needling is sometimes performed by physical therapists or chiropractors. If you need Medicare to cover your treatment, make sure that you are receiving acupuncture and not dry needling.
Chronic Low Back Pain Requirements
If Medicare will only cover acupuncture for the treatment of chronic low back pain, what are the requirements for a condition to qualify as chronic low back pain? Here are the requirements that your condition must meet before Medicare pays for your treatments. First, the pain must have lasted for 12 weeks or longer. Pain that has only begun within the last 12 weeks will not meet the requirements of chronic low back pain.
Next, the chronic lower back pain must have no identifiable source. For example, if you have an inflammatory disease that is causing the pain, then Medicare will not cover acupuncture treatments for the pain. Basically, the pain can’t be caused by an infection or an inflammatory disease like, for example, osteoarthritis. Finally, the pain must not be associated with surgery or pregnancy. If you are pregnant or have had a recent surgery that could be causing the pain, then Medicare will not cover acupuncture treatments.
Finding An Acupuncture Provider With Medicare
In addition to making sure that your condition qualifies for coverage, you must also use a provider that Medicare covers. Not all acupuncture providers will meet the requirement. Your treatments must be provided by a doctor or another health care provider, like a nurse practitioner or physician’s assistant. Next, your provider must have the following two essentials:
- A master’s 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 you’re getting care
If your provider does not possess the two qualifications above, then Original Medicare will not provide coverage. Note that your provider must be a licensed acupuncturist. Not all doctors will possess a license to practice acupuncture, so you will need to search for providers in your area who meet these requirements. When making your appointment, you should go ahead and ask the provider whether they will accept Medicare. While they might accept plans from other insurance companies, you will want to ensure that your provider will accept Medicare. Otherwise, you might find yourself attempting to get reimbursed from Medicare after you pay the bill in full.
It is possible that other health insurance plans could cover acupuncture from providers who do not meet the Medicare requirements, but you would need to check the details of those plans to determine their coverage requirements. Some Medicare Advantage plans or Medigap plans might even provide additional coverage.
How Much Does Medicare Pay For Covered Acupuncture?
Remember that the services you receive under Medicare coverage are subject to deductibles, copays, and coinsurance amounts. Medicare Part A and Medicare Part B have different cost-sharing amounts, so it is important to distinguish which part of Medicare covers a particular service. In this case, acupuncture is covered by Medicare Part B.
Once your deductible has been met, Medicare Part B usually pays for 80% of covered services. The Part B deductible is $226, so this means that you will pay the first $226 out of your own pocket. Once your deductible is met, Medicare will pay for 80% of the Medicare-approved cost of your acupuncture treatments. This is another reason why it is a good idea to make sure that your provider will accept Medicare coverage. They might charge you more than the Medicare-approved amount if they do not take Medicare. In that case, you would need to pay the difference out of pocket. Let’s take a look at an example.
Suppose you have already met your Part B deductible, and you go get acupuncture that meets all the Medicare requirements. Medicare Part B covers 80% of the Medicare-approved amount, so imagine that the Medicare-approved amount is $100. You would be responsible for paying $20 for the service.
Now, imagine that the provider charged you $140 for the service. The Medicare-approved amount is still $100, so Medicare will only pay $80 for the acupuncture session. In this case, you would be responsible for paying $60 for the acupuncture session. Now you can see why it is so important to make sure that your provider accepts Medicare before you receive medical treatment. Otherwise, you might be stuck with a much higher bill than you expected.
Acupuncture Coverage With Medicare Advantage Plans
Now that you know what it takes for Original Medicare to cover acupuncture, what about Medicare Advantage plans? The answer depends on which Part C Advantage plan you have. You may already know that these plans combine your Part A and Part B coverage into a single plan. Many of the plans include additional benefits as well, like prescription drug coverage, dental benefits, vision coverage, and even gym memberships. These plans are managed by private insurance companies, like UnitedHealthcare or Cigna, and they can set their own coverage rules. The only requirement is that each plan must provide the same minimum level of coverage that is provided by Original Medicare.
Some Medicare Advantage plans provide coverage for acupuncture services that extends beyond the coverage provided by Original Medicare. In some cases, your plan might pay for acupuncture services even if there is a systemic cause for your pain. Similarly, your plan might pay for other alternative medicines or treatments for your pain. You should check with your insurance company for coverage details.
If you want to find a Medicare Advantage plan that provides coverage for acupuncture beyond traditional Medicare coverage of acupuncture, you should use the plan finder tool available at Medicare.gov. This tool allows you to see all the plans available in your area and easily compare them.
Acupuncture Coverage With Medicare Supplement Plans
Some Medicare beneficiaries choose to sign up for a Medigap plan to help cover out-of-pocket expenses not covered by Original Medicare. So, does Medigap pay for acupuncture services? Remember that you must be enrolled in Original Medicare to be eligible for a Medigap plan. These plans help cover out-of-pocket expenses associated with Medicare, like your deductibles, copays, and coinsurance amounts.
So, it is possible that your Medigap plan might cover the coinsurance amount that is required when you receive acupuncture treatment. The details of these plans vary from one plan to the next, so you should check your plan’s specifics to determine what it will pay for. Remember that Medigap plans will only help with costs for services that are covered by Medicare. If you receive acupuncture treatment that is not covered by Medicare, your Medigap plan will not pay for it.
Are Chiropractic Services Covered By Medicare
Now that you know Medicare coverage details for acupuncture, what about Medicare coverage for chiropractic services? Medicare will cover other chiropractic services, but that coverage is limited to a chiropractor’s manual manipulation of the spine to correct a subluxation. Other services that are ordered by the chiropractor, like X-rays or massage therapy, are not covered.
Just like with acupuncture, you might find that your Medicare Advantage plan provides additional coverage beyond what Original Medicare covers. You would need to check your plan’s documentation to learn about the details of that coverage.
The Bottom Line
Medicare does cover acupuncture, but certain conditions must be met. Acupuncture must be for the treatment of chronic lower back pain, and the provider must meet the requirements established by Medicare. Getting acupuncture for the treatment of other types of pain or for general wellness will not meet the requirements, and the service will not be covered by Medicare. Some Medicare Advantage plans provide additional coverage for acupuncture, but you should check the details of your plan to learn exactly which services will be covered.
Frequently Asked Questions
Can acupuncture be claimed on Medicare?
Yes, acupuncture can be claimed on Medicare as long as it meets the requirements established by Medicare. The service must be for treating chronic lower back pain, and it must be provided by a licensed doctor or health care professional who has received the proper training. Medicare has certain degree requirements that a provider must possess before the service is covered.
Is it necessary to have a diagnosis to get acupuncture covered by Medicare?
Yes, your chronic lower back pain must meet certain conditions before Medicare covers acupuncture services. First, the pain must have lasted for at least 12 weeks. Next, there must be no identifiable cause of the pain, such as an infectious disease or inflammatory disease. Finally, the pain must not be caused by pregnancy or surgery. If your diagnosis confirms these criteria, then your treatments can be covered by Medicare.
What acupuncture treatments are covered by Medicare?
Only acupuncture treatments for chronic lower back pain are covered by Medicare. Treatments for any other type of pain or wellness will not be covered. Also, only 12 visits during a 90-day period will be covered. If your condition is improving, Medicare will cover an additional eight visits. Under no circumstances will Medicare pay for more than 20 acupuncture sessions in a 12-month period.
When did Medicare start covering acupuncture?
Medicare started covering acupuncture in 2020 for the treatment of chronic lower back pain. One major deciding factor was the number of opioid addiction cases currently in the United States. Some patients can manage their pain without these medications by using acupuncture treatments. It is possible that Medicare could expand its coverage to include acupuncture treatments for other types of pain in the future.
