Does Medicare cover acupuncture?
The first reported use of acupuncture was approximately 3,000 years ago in China. Practitioners applied small needles at specific points in the body during acupuncture, often to relieve pain. Today, acupuncture is a popular and effective non-drug and non-invasive treatment option for a variety of health issues.
Medicare coverage for acupuncture
Until January 2020, Medicare did not cover acupuncture treatments. However, that month the Centers for Medicare and Medicaid Services (CMS) announced a change.
“We are dedicated to increasing access to alternatives to prescription opioids and believe that covering acupuncture for chronic low back pain is in the best interest of Medicare patients,” said CMS Principal Deputy Administrator of Operations and Policy Kimberly Brandt in a press release.
Medicare Part B now covers up to 12 acupuncture visits in 90 days for chronic low back pain. If patients show improvement during those first 12 sessions, eight additional sessions may be covered, for a maximum of 20 acupuncture treatments in a 12-month period.
The cost for each session would be the standard 20% of the Medicare-approved amount after meeting the Part B deductible.
What is chronic low back pain
While many of us have low back pain from time to time, CMS defines chronic low back pain, which qualifies for Medicare coverage, as the following:
- Lasting at least 12 weeks
- Has no identifiable cause associated with a disease or infection
- Is not associated with surgery or pregnancy
How does acupuncture treat low back pain
While acupuncture may offer relief from a variety of health issues, many studies show that it is particularly effective for low back pain—the number one reason people seek out acupuncture.
One review of studies showed that acupuncture provided short-term relief from chronic back pain. Another analysis of data from 20 studies of people back pain, osteoarthritis, neck pain, or headaches, found that the benefits of acupuncture continued for a year after treatment ended for all conditions except neck pain.
How acupuncture works for back pain is not completely understood. Acupuncture may directly affect the tissue where the needles are inserted. It may also cause the release of endorphins, which essentially turn off pain.
Who can provide Medicare-covered acupuncture?
Under current CMS guidelines, licensed and degreed acupuncturists can only provide Medicare-covered acupuncture if they are supervised by an on-staff medical doctor (MD), physician Assistant (PA), nurse practitioner (NP), or a clinical nurse specialist (CNS). This is challenging for many Medicare beneficiaries.
“This is a huge problem,” says Mori West, CPC, insurance committee chair of the American Society of Acupuncturists, and CEO of ACUCLAIMS, “because 95% of all acupuncturists work independently, and don’t have an MD, PA, NP, or CNS on staff.”
That means only 1,000 or so acupuncturists nationwide are able to offer services covered by Medicare.
West has been communicating with CMS to find some workarounds, and Representative Judy Chu (D-CA) introduced bill H.R.3133 – Acupuncture for Our Seniors Act of 2023 which, if passed, would allow acupuncturists to be enrolled in Medicare and bill directly, removing the need for supervision.
Medicare Advantage coverage of acupuncture
Medicare Advantage plans mirror Medicare acupuncture benefits, so they offer the same coverage for chronic low back pain. However, providers must still have a medical doctor on staff to provide Medicare-covered acupuncture.
Some Medicare Advantage plans, as part of a bundle of additional coverage, may cover routine acupuncture for a variety of conditions, including, but not limited to, chronic low back pain.
Medicaid coverage for acupuncture
“A number of states offer Medicaid coverage for acupuncture,” says Tuesday Wasserman, doctor of acupuncture and Chinese medicine, and Medicaid committee chair of the American Society of Acupuncturists.
Those states include Washington, Oregon, California, New Mexico, Colorado, Minnesota, Missouri, Illinois, Ohio, Florida, New Jersey, New York, Massachusetts, Connecticut, Maryland, and coverage varies by state.
Community acupuncture
A new, more affordable type of acupuncture is available in many parts of the country.
“Community acupuncture offers a ‘pay what you can’ or lower cost model, where a group of people sit in lounge chairs and get acupuncture based on their health challenge,” says West.
Spearheaded by the low-cost acupuncture training school People’s Organization of Community Acupuncture, the organization offers a directory of community acupuncture clinics.
