Medicare and Acupuncture
Yes, Medicare will cover acupuncture treatment under Medicare Part B. But there is more to the story. First, let’s define acupuncture for Medicare’s purposes. Acupuncture is a technique where providers stimulate specific points on the body, most often by inserting thin needles through the skin.
Acupuncture under Medicare is subject to certain limitations and conditions. Additionally, Medicare Advantage plans may offer different coverage options, so check your enrollment guide, call your plan or better still, call your personal Advantage Plan Agent for details. For original Medicare information, I always go to Medicare.gov or the “What’s Covered” Medicare app on my smart phone.
Medicare Part B covers up to 12 acupuncture visits in 90 days for CHRONIC LOWER BACK PAIN. For lower back pain to be considered chronic, you must meet the following criteria:
- The pain has been lasting 12 weeks or longer.
- The pain is not associated with a related diagnosis such as:
- Cancer that has spread.Infectious or inflammatory disease.
- The pain is not associated with surgery or pregnancy.
Prior Authorization. It is not enough to claim that you have chronic lower back pain. Your provider must submit documentation that demonstrates medical necessity and compliance with Medicare’s coverage criteria.
I’ve mentioned the 12 visits in 90 days above. Good news, if you show signs of improvement, Medicare will approve an additional 8 sessions for a total of 20 visits. If there is no sign of improvement during the initial 12 visits, treatment will be discontinued under Medicare.
Let’s talk about where you can go for treatment. You need to be careful about who gives you the treatment. Medicare won’t pay for treatments directly from Licensed Acupuncturists. You need to get acupuncture from a doctor or another healthcare provider who has the following:
- A masters or doctoral level degree in acupuncture or Oriental Medicine.
- Degree must be from a accredited school.
- Proper, active license to practice acupuncture in the state where you’re getting care.
As I often say, Medicare has your back. There are restrictions but I’m sure these are in place to protect patients and taxpayers against fraud, waste, and abuse.
Keep in mind, if you have a Medicare Supplement Plan, it only helps with what Medicare approves. If Medicare doesn’t pay, your Supplement Plan won’t either. Medicare Advantage Plans can be different, so ask your agent. You can call me toll-free at: 888-8836074, or email me at: Jack@Yes2Medicare.com.