Does Medicare Pay for Acupuncture?
- Medicare covers acupuncture treatments under certain circumstances. Learn how Medicare pays for acupuncture and what to ask your doctor.
Historically, Original Medicare (Medicare Part A and Part B) did not offer any coverage for acupuncture, but that changed in January of 2020.
On January 21, 2020, the Centers for Medicare & Medicaid Services (CMS) finalized the decision that Medicare will cover acupuncture for patients with chronic lower back pain.
The decision was based partly on recent studies showing positive results for patients receiving acupuncture treatment, and it’s part of a continued effort to expand Medicare coverage of non-opioid pain management.
When Will Medicare Cover Acupuncture?
Acupuncture is covered by Medicare Part B. In order for the acupuncture to be covered, the patient must be experiencing chronic back pain.
Chronic back pain is defined as:
- Pain that has persisted for 12 weeks or longer
- Pain that is not related to cancer, infectious disease, inflammation, pregnancy or surgery
If a beneficiary’s lower back pain meets the above guidelines to be classified as chronic pain, Medicare Part B will cover up to 12 session of acupuncture treatment in 90 days. Medicare will then cover an additional eight sessions if the beneficiary shows signs of improvement, for a total of 20 covered sessions. No more than 20 treatments will be covered in the same calendar year.
Will My Doctor Accept Medicare for Acupuncture?
Medicare will only cover acupuncture when it’s performed by a doctor or other health care provider who possesses the following credentials:
- A master’s degree or doctorate degree in acupuncture or traditional Asian medicine from a school that is accredited by the Accreditation Commission on Acupuncture and Oriental Medicine
- An active and unrestricted license to practice acupuncture in the state where the service is being provided
Original Medicare does not cover acupuncture for any other condition besides lower back pain.
How Much Does Acupuncture Cost With Medicare?
The official government website for Medicare has not yet released any cost details for Medicare acupuncture coverage.
Most health care services covered by Medicare Part B are subject to the annual Part B deductible ($198 in 2020) and typically a 20% coinsurance payment for all remaining charges after the deductible has been satisfied.
Do Private Medicare Plans Cover Acupuncture?
While the 2020 ruling allows Original Medicare to cover acupuncture, some Medicare Advantage (Medicare Part C) plans were already covering it.
By law, Medicare Advantage plans must provide at least the same basic benefits as Original Medicare. So any Medicare Advantage plan that did not previously cover acupuncture must now do so in order to align with the acupuncture coverage offered by Part B.
Medicare Advantage plans may also offer expanded coverage or additional benefits for other services not covered by Original Medicare. So there may be some Medicare Advantage plans that offer acupuncture coverage beyond just the chronic lower back pain coverage that is now found under Part B.
Most Medicare Advantage plans also offer prescription drug coverage, which may include prescriptions to help with chronic pain. Original Medicare doesn’t typically cover prescription drugs.
Acupuncture is a form of alternative medicine and one of the key components of traditional Chinese medicine. Acupuncture can stimulate specific points on the body by inserting thin needles through the skin. It is most often performed to treat pain, but is also used for migraines, nausea and vomiting caused by chemotherapy, cramps and more.
Alternative medicine is typically not covered by Medicare, so the decision to offer Medicare acupuncture coverage was not insignificant.
Thousands of Americans die every year as a result of opioid addiction, and the addition of acupuncture to the list of covered Medicare benefits is a signal that Medicare is making good on its commitment to expand coverage of pain relief therapies that don’t involve opioids.