Does Medicare Cover Acupuncture for Neuropathy?

Medicare beneficiaries often inquire about coverage for therapies like acupuncture. This article clarifies Medicare’s current stance on covering acupuncture, particularly focusing on its application for neuropathy.

General Medicare Coverage for Acupuncture

Medicare Part B covers acupuncture for chronic low back pain. This specific type of pain is defined as lasting for 12 weeks or longer, having no identifiable systemic cause (such as metastatic cancer), not being associated with surgery, and not being pregnancy-related.

For those who meet the criteria, Medicare covers up to 12 acupuncture sessions within a 90-day period. If improvement is shown, an additional 8 sessions may be covered, bringing the maximum total to 20 sessions per calendar year. These services must be performed by a physician or other practitioners (physician assistants, nurse practitioners, or clinical nurse specialists) legally authorized to provide acupuncture in their state and operating within their scope of practice.

Acupuncture for Neuropathy Coverage

Medicare’s acupuncture coverage is primarily limited to chronic low back pain. Neuropathy itself is not a directly covered condition for acupuncture treatment. If a patient seeks acupuncture solely for neuropathy, it will likely not be covered.

However, a patient with neuropathy might receive covered acupuncture if their condition contributes to or is directly associated with chronic low back pain that meets Medicare’s criteria. For instance, if neuropathy causes or exacerbates chronic low back pain that fits the Medicare definition, acupuncture for that specific pain might be considered. Medical necessity and a physician’s referral are paramount to establish the link between the neuropathy and the covered chronic low back pain.

A neuropathy diagnosis does not automatically qualify an individual for acupuncture coverage. The treatment must specifically address chronic low back pain that meets the program’s strict guidelines. If a patient with neuropathy seeks acupuncture for symptoms or conditions other than Medicare-defined chronic low back pain, the services will typically not be covered.

Understanding Medicare Costs and Limitations

Acupuncture services covered by Medicare fall under Part B. Beneficiaries are responsible for the Part B deductible, which for 2025 is $240. After the deductible is met, Medicare typically pays 80% of the approved amount. This means the beneficiary is responsible for the remaining 20% coinsurance.

Any sessions beyond the annual limit of 20 or services for conditions not covered by Medicare, such as neuropathy not linked to chronic low back pain, are 100% out-of-pocket. Medicare Advantage Plans (Part C) must cover at least the same services as Original Medicare, but may offer different cost structures or additional benefits. Check with your specific plan provider for details on their acupuncture coverage and associated costs.

Finding Covered Services and Providers

To determine if acupuncture services are covered, consult your primary care physician. They can discuss your neuropathy, assess its potential connection to chronic low back pain, and provide a referral if appropriate and medically necessary. A physician’s assessment is a key first step in navigating Medicare coverage for acupuncture.

You should also directly contact Medicare or visit their official website to confirm current coverage policies and your specific eligibility. Medicare’s “Physician Compare” tool can help you find licensed acupuncturists who accept Medicare assignments and can bill the program directly.

Before receiving any services, verify the provider’s Medicare participation status. Confirming that the acupuncturist accepts Medicare assignments ensures services, if covered, will be processed through your Medicare benefits.