Does Medicare Cover Acupuncture?Learn about how Medicare will pay for your acupuncture treatment and what you need to do to get your treatment covered.
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Acupuncture is becoming more and more popular as an alternative treatment for illness and pain.
If you’re a Medicare beneficiary, you might be able to get your acupuncture therapy covered by your Medicare Part B insurance.
This article will help you learn whether Medicare will pay for your acupuncture treatment, what you need to do before you’re covered, and how much it will cost you.
What Is Acupuncture?
Acupuncture is a form of alternative medicine that uses needles to stimulate specific body parts. While the science is unclear, acupuncture is known to help relieve symptoms of:
Dental pain after surgery
Lower back pain
Carpal tunnel syndrome
Does Medicare Cover Acupuncture?
The federal Medicare program offers limited coverage for acupuncture as a form of medical treatment.
Medicare only covers beneficiaries for acupuncture treatment that deals with chronic lower back pain.
Chronic low back pain is defined as:
Lasting 12 weeks or longer (chronic pain).
Having no known cause such as cancer, injuries, surgery, or pregnancy.
Keep the following points in mind if you want to get acupuncture covered by Medicare:
As a general rule, all treatments must be medically necessary for the Centers for Medicare & Medicaid Services (CMS) to cover them.
Before you go for acupuncture, it’s essential to get a written recommendation from your doctor or healthcare provider.
You will also need to use a registered and qualified acupuncturist in your state for Medicare to cover your treatment.
What Does Medically Necessary Mean?
For a treatment to be medically necessary, it must be needed to identify or treat sickness, injury, ailment, disease, or its symptoms.
Medicare will not cover all the specialist treatments that a person wants or needs. They have strict guidelines on what a person can claim. One of these is whether a procedure, treatment, test or service is medically necessary.
How Many Treatments Will Medicare Cover?
If you have chronic lower back pain, you will be able to get 12 acupuncture visits over 90 days. This is covered under Medicare Part B.
For example, if you get a recommendation from your doctor for acupuncture in January, you will be able to go for weekly acupuncture sessions over the next three months (90 days).
After your first 12 treatments, you will have to go back to your examining physician to determine whether the acupuncture is helping to alleviate your symptoms.
If the physician decides that the patient is showing improvement, Medicare will cover a further 8 sessions with an acupuncturist.
A person is limited to 20 acupuncture treatments per year, which means Medicare won’t cover you if you decide to continue with acupuncture after this.
Will Medicare Advantage Cover Acupuncture?
Medicare Advantage plans are required by law to provide the same level of coverage as Original Medicare.
As a Medicare Advantage member, you get 12 standard acupuncture treatments and eight additional acupuncture sessions just as you would if you had Original Medicare.
However, if you want to get all of your costs covered as a member of an HMO or PPO plan, you may have to go to specific doctors and acupuncturists to be covered by these types of Medicare Advantage plans.
What Are HMOs and PPOs?
HMOs (Health Maintenance Organizations) are a type of health plan that only covers member costs if they go to medical providers that are part of their plan’s network.
PPOs (Preferred Provider Networks) also work as a network health plan, but will cover some of the costs if a member decides to use a medical provider that is not part of their network of preferred providers.
Depending on your provider, HMO and PPO Medicare Advantage plans might fully cover acupuncture if you use a provider in their network.
Otherwise, you’ll have to pay 20% of the costs like a Medicare beneficiary with Original Medicare.
Tips for Finding a Licensed Acupuncturist in Your State
Medicare will only cover acupuncture treatments for chronic lower back pain from an acupuncturist registered with a qualifications board in your state.
If you have lower back pain and would like to get acupuncture treatment, our advice is to discuss this with your physician or reach out to the CMS to find out what you should do.
The CMS defines a qualified acupuncturist as someone who:
Has a master’s or doctoral degree in acupuncture or oriental medicine.
Received their qualification from a school recognized and accredited by the Accreditation Commission on Acupuncture and Oriental Medicine (ACAOM).
Has a license to practice acupuncture in the state where their services are offered.
Follow these tips if you want to find an acupuncturist who meets these guidelines.
Contact the ACAOM and ask them for a list of members in your region.
Contact the Centers for Medicare & Medicaid Services or your Medicare Advantage plan and find out if they have the contact details of acupuncturists in your area.
There are no state qualification requirements for acupuncturists in some cases. For example, in Alabama, Oklahoma, and South Dakota.
If your state does not have a state qualification for acupuncturists, you may need to go for treatment in a neighboring state if you want Medicare to cover your acupuncture treatments.
Terms you should know:
Coinsurance: These are a part of the costs that beneficiaries must pay for. They can be a percentage of the total expenses or be charged at.
Deductibles: These are amounts you must pay before Medicare covers your medical expenses.
Medically necessary: This means that a registered medical professional, such as a doctor or medical specialist, has decided that a treatment or procedure must happen to fix or cure an illness or disease.
What Will Acupuncture Cost If Medicare Covers Me?
The price of acupuncture will vary based on your practitioner and your location. You can expect to pay anywhere between $50 to a few hundred dollars for different kinds of acupuncture treatments.
With Medicare coverage, you can use the general rules for Part B to determine how much you will pay for treatment.
Part B Medicare pays 80% of outpatient or non-hospital medical expenses and will cover acupuncture for chronic low back pain.
Medicare beneficiaries cover the remaining 20%, known as a coinsurance amount. For example, if your medically necessary acupuncture therapy costs $110 per session:
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Just remember that you also have to pay an annual deductible for Part B coverage. This is the amount you have to pay before Medicare Part B covers your acupuncture. In 2022, the Part B deductible is $233.
Does Medicare Cover Other Complementary or Alternative Care?
As long as the CMS determines the treatment is medically necessary, Medicare will cover alternative treatment or care.
If access to holistic medicine is important to you, consider purchasing a Medicare Advantage plan that offers coverage for these services. Speak to one of our agents about your Medicare Advantage options.
Where Can I Learn More about Medicare Coverage?
Visit our Medicare hub if you’re interested in Medicare or Medicare Advantage, or have questions about coverage, costs, or enrolling in the federal government health scheme.
We have tons of information and articles covering topics like choosing a Medicare plan, finding Medicare Supplement Insurance, and learning about Medicare Advantage in your state.