Does Medicare Cover Acupuncture in 2022?
Get clear answers on Medicare's acupuncture coverage, including eligibility, access, and beneficiary financial responsibilities.
Medicare is a federal health insurance program for individuals aged 65 or older, some younger people with disabilities, and those with End-Stage Renal Disease. Acupuncture, a traditional Chinese medicine technique, involves inserting thin needles into specific points on the body to stimulate nerves and promote wellness. Medicare covers certain acupuncture services, providing beneficiaries with access to non-opioid pain management therapies for specific conditions.
Medicare Part B Coverage for Acupuncture
Medicare Part B covers acupuncture for chronic low back pain. This pain is defined as lasting 12 weeks or longer and must be non-specific, meaning it has no identifiable systemic cause like metastatic cancer, inflammatory disease, or infection. It also cannot be associated with surgery or pregnancy.
Medicare Part B covers up to 12 acupuncture treatments within a 90-day period. If a patient shows improvement, Medicare may cover an additional eight sessions. The total is capped at 20 treatments within a 12-month period. If chronic low back pain does not improve, Medicare will not cover additional sessions.
Accessing Covered Acupuncture Services
For Medicare to cover acupuncture, services must be provided by qualified healthcare professionals. These include physicians, physician assistants, or nurse practitioners legally authorized to perform acupuncture in their state. Auxiliary personnel, like licensed acupuncturists, can provide services under the supervision of one of these professionals. All providers must hold a master’s or doctoral degree in acupuncture or Oriental Medicine from an ACAOM-accredited school and a current, unrestricted state license.
Beneficiaries should confirm their provider is Medicare-enrolled and accepts assignment. Accepting assignment means the provider agrees to accept the Medicare-approved amount as full payment. The treating physician must also certify the medical necessity of acupuncture for the beneficiary’s chronic low back pain for coverage to apply.
Costs for Acupuncture
Beneficiaries are responsible for certain costs associated with covered acupuncture services under Medicare Part B. The annual Medicare Part B deductible applies. After this deductible is met, Medicare typically pays 80% of the Medicare-approved amount for covered acupuncture treatments.
The beneficiary is responsible for the remaining 20% coinsurance. These cost-sharing obligations apply specifically to acupuncture for chronic low back pain. If acupuncture is received for other conditions, or from a provider not Medicare-enrolled or not accepting assignment, the beneficiary will be responsible for 100% of the costs.