Until recently, Medicare has not covered acupuncture. As of January 2021, CMS announced some changes regarding this.
What Exactly is Acupuncture?
Acupuncture is a type of traditional Chinese Medicine that was developed several thousand years ago. The procedure involves very thin needles that are inserted through your skin at strategic points on your body. Acupuncture is mostly used to treat pain however, many people use it as alternative medicine for overall wellness including stress management.1
Things to know
With the opioid crisis in full swing, Medicare has added acupuncture coverage in place as part of a growing effort to help people access nonopioid pain management.
On January 21, 2020, the Centers for Medicare & Medicaid Services (CMS) announced that they would cover acupuncture services to help treat chronic lower back pain. Previously, Medicare did not cover acupuncture to treat any condition, but under the new rules, Medicare beneficiaries could receive some of these treatments under Part B.
You’ll need to follow certain guidelines if you want Medicare to cover your acupuncture visits. The first thing is to remember is Medicare doesn't cover acupuncture for any condition other than chronic lower back pain.
Medicare will cover chronic lower back pain that has lasted a minimum of 12 weeks. It cannot be related to cancer that has spread, inflammatory, or infectious disease. It also can’t be caused by surgery or pregnancy.
You must use an accredited acupuncturist. This means they have a master's or doctoral-level degree in acupuncture or Oriental Medicine.
And your acupuncturist must carry a current, full, active, and unrestricted license to practice acupuncture in the state where you are receiving care.
Medicare Part B will cover up to 12 acupuncture visits in 90 days. If you are showing improvement, Medicare will cover an additional 8 sessions. However, if your provider decides your condition isn't improving or is getting worse, Medicare will not cover any additional sessions.
No more than 20 acupuncture treatments can be given yearly.
How much does Acupuncture Cost?
Acupuncture costs can vary according to your provider and where you live. Your first appointment may cost the most money because you will likely need to pay for the consultation as well as any treatment.
As of 03/17/2021, Medicare has not indicated how much they will pay for acupuncture treatment. But once they establish the fee, understand that if you have Medicare Part B, you’ll be responsible for the Part B deductible and your co-insurance amount of 20%. But, if you have a Medicare Supplement Plan, it will likely cover part of those costs. For example, if you have a Plan F (no longer available to new Medicare beneficiaries as of 1/1/2020) it will cover at 100%. If you have a Plan G, you’ll pay the Part B deductible, and then Plan G will pick up the 20%.
Without Medicare, depending on where you live, you may expect to pay $120 up to $300 for the first session and between $75 and $300 for treatments after that.
Because costs can vary, ask how much your session will cost. Also, be sure to get an estimate in writing, if you can.
Does a Medicare Advantage plan also cover Acupuncture?
Some Medicare Advantage Plans have been covering acupuncture prior to the new regulations. But not all.
With this new regulation, Medicare Advantage Plans, also called MA plans, MAPD plans, or Medicare Part C, must also cover acupuncture treatment of lower back pain. 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.
Keep in mind that some Medicare Advantage plans may provide expanded acupuncture coverage to treat other conditions. Medicare Advantage Plans can offer benefits that are richer than what original Medicare might pay. But, read your plan because you might still have to pay a deductible or copay when you receive acupuncture treatment.
And don’t forget that if you are in a Medicare Advantage Plan you may need to use in-network providers.
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- what is acupuncture – Google Search, https://www.google.com/search?sxsrf=ALeKk00yO61qx5W8knc4oWJKDvtnjDVTcQ%3A1615846994710&ei=Ut5PYI_7KtPT-wTglLGACA&q=what is acupuncture&oq=what is accupun&gs_lcp=Cgdnd3Mtd2l6EAMYADIECAAQCjIECAAQCjIECAAQCjIECAAQCjIECAAQCjIECAAQCjIECAAQCjIECAAQCjIECAAQCjIECAAQCjoECCMQJzoECAAQQzoLCC4QxwEQrwEQkQI6CAguEMcBEKMCOgIIADoFCAAQkQJQ36EaWPSyGmDkwBpoAHACeACAAaMBiAHuD5IBBDAuMTaYAQCgAQGqAQdnd3Mtd2l6wAEB&sclient=gws-wiz
- In a first, Medicare will now cover acupuncture (but only in certain cases), https://www.advisory.com/en/daily-briefing/2020/01/23/acupuncture
- Acupuncture coverage, https://www.medicare.gov/coverage/acupuncture
- Acupuncture and Alternative Medicine: Does Medicare Cover It? https://www.healthline.com/health/medicare/does-medicare-cover-acupuncture#cost
- Medicare and acupuncture: Coverage, exclusions, and requirements, https://www.medicalnewstoday.com/articles/does-medicare-cover-acupuncture#summary