Does Medicare cover acupuncture? When considering Medicare coverage in general, acupuncture is commonly grouped in the same medical category as chiropractic care and massage therapy. CMS and Medicare have been slow to properly recognize acupuncture as an effective medical treatment.
The traditional Chinese acupuncture treatment dates back over to 2,000 years to 100 BC. Interestingly, Americans had to wait until the 1970’s for acupuncture to be introduced into the American healthcare system. Today there are over 7,000 Acupuncturists practicing in the United States, including medical doctors and nurse practitioners.
Acupuncture is considered a “complementary and alternative” medicine with its placement of extremely thin needles through the skin at strategic points in the body to treat chronic neck and back pain. It is commonly used to also treat headaches, chronic fatigue syndrome, fibromyalgia, asthma, gastrointestinal disorders, asthma, irritable bowel syndrome, nausea associated with chemotherapy, and sports injuries.
Does Medicare Cover Acupuncture ?
Yes, Medicare will cover acupuncture treatments, but only for chronic low back pain. For chronic lower back pain, acupuncture is covered under Medicare Part B (Medical coverage) for up to 12 acupuncture visits over a span of 90 days. After 90 days, if your doctor can document that those 12 acupuncture treatments have improved your chronic low back pain recovery, then Medicare may approve an additional 8 acupuncture treatments. That’s a maximum annual total of 20 acupuncture sessions over the period of a year. [1]
Medicare and Chronic Low Back Pain (LBP)
For lower back pain to be considered a chronic condition, the CMS Medicare coverage standard requires the pain to be a condition that lasts longer than 12 weeks. Further, Medicare also requires the chronic lower back pain to be “non-specific” health condition without any known cause. Interestingly, non-specific low back pain is attributed to 85% of chronic back problems and Medicare claims. Basically, if you’re seeking acupuncture therapy, be aware of these prerequisites as your consult with your doctor.
Medicare coverage can be a maze with pitfalls of coverage denials. This is where Medicare coverage exceptions come into play (i.e. “Sorry, Medicare doesn’t cover that acupuncture under that specific condition.”). For Medicare to approve acupuncture treatments, your chronic lower back pain cannot be knowingly caused by the spread of a disease, infection, or inflammation. Additionally, Medicare won’t cover acupuncture treatments for low back pain caused by pregnancy and surgery.
Bottom-line answer to “Will Medicare cover acupuncture?”
Your chronic low back pain must be “non-specific” in order for Medicare to approve the coverage of acupuncture treatments.
Did You Know Acupuncture Coverage is Medicare’s Answer to Opioid Crisis
Chronic pain is one of the driving factors that led to the opioid crisis. Over the past twenty years, doctors encoraged patients to self-classify their level of pain and actively participate in treatment of that pain through pain relieving drugs. Unfortunately this medical approach contributed to the widespread dependency on opioids like hydrocodone (Vicodin) and oxycodone (OxyContin). Medicare patients have been a large segment of the opioid abusing population over this time. Additionally, chronic low back pain has been one of the most common opioid-prescribed conditions. It was the Department of Health & Human Services under the Trump Administration that introduced acupuncture coverage as a alternative treatment to opioid pain medicines.
In a January 21, 2020 CMS press release, HHS Secretary Alex Azar announced:
“Expanding options for pain treatment is a key piece of the Trump Administrations’ strategy for defeating the opioid crisis. President Trump has promised to protect and improve Medicare for seniors, and deciding to cover this new treatment option is another sign of that commitment. Medicare beneficiaries will now have a new option at their disposal to help them deal with chronic low back pain, which is a common and sometimes debilitating condition.” [2]
There are over 2.1 million people 65 and older who experience chronic pain. Within that population, CMS reports that nearly 35% (900,000) experience “high-impact” chronic pain.
Do Medicare Advantage Plans Pay for Acupuncture?
As you may know, Medicare beneficiaries can get their Medicare benefits in two ways: 1.Original Medicare (Medicare Parts A and B) or 2. An “all-in-one” Medicare Advantage plan offered by health insurance company like UnitedHealthcare, Cigna, Humana or Aetna.
Medicare Advantage plans maintain the same level of coverage as Original Medicare; however, Medicare Advantage plans offer additional benefits such as dental, vision, and prescription drug plans (Part D).
Medicare Advantage companies commonly advertise acupuncture treatment as an additional coverage benefit. Their goal is to advertise a “something for everyone” proposition and pique the interests of people actively seeking acupuncture coverage.
Caveat emptor: Advertised Acupuncture coverage benefits are generally misleading. As you’ll see in review of the largest Medicare Advantage insurance carriers, most Medicare plans only offer the limited acupuncture coverage for chronic low back pain only — just like Original Medicare.
Do UnitedHealthcare Medicare plans pay for Acupuncture?
UnitedHealthcare is the largest Medicare Advantage plan provider with a market share of 24%. This is of no special significance to anyone looking for acupuncture benefits because UHC’s Medicare Advantage plans only cover acupuncture for chronic low back pain. Their coverage of acupuncture treatments is inline with CMS’ standard coverage guidance of a maximum of 20 acupuncture sessions over a year, for non-specific chronic lower back pain issues. UHC’s Medicare Advantage plans do not cover acupuncture for common health issues such as arthritis, depression, headaches, muscle aches, stress management, and weight loss.
Do Humana Medicare plans pay for Acupuncture?
Humana is the second largest Medicare Advantage company, commanding a competitive 20% of the market. For acupuncture benefits, Humana’s Medicare Advantage plans do not vary from CMS’ standard coverage options for acupuncture treatment. Just like UHC, Humana’s Medicare Advantage plans only offer acupuncture coverage for chronic low back pain only. See Humana’s explanation of Medicare and acupuncture.
Do BlueCross BlueShield (BCBS) Medicare plans pay for Acupuncture?
As one of the oldest household names in Medicare and health insurance, BlueCross BlueShield (BCBS) is the third largest player in the Medicare Advantage space. With 15% market share, BCBS follows the pack and offers no special acupuncture benefits. BlueCross BlueShield Medicare Advantage plans only cover acupuncture for chronic low back pain, which is Original Medicare’s basis minimum coverage.
Do Aetna Medicare plans pay for Acupuncture?
Aetna Medicare Advantage plans only cover acupuncture for chronic low back pain. Aetna’s Medicare Advantage plans are relatively a standard-minimum option for Medicare beneficiaries seeking acupuncture services. Consistent with CMS standards, Aetna’s Medicare Advantage plans cover the basic 12 sessions for chronic low back pain, and an additional 8 if the acupuncture treatments are documented as helpful to recovery.
Do Kaiser Permanente Medicare plans pay for Acupuncture?
Kaiser Permanente is a regional juggernaut; however, Kaiser Permanente’s Medicare Advantage plans fall in line with Original Medicare and only cover acupuncture for chronic low back pain.
Do Centene Medicare plans pay for Acupuncture?
Centene in a large Medicare company with regional strength across the country under the names of Health Net and Wellcare. With 5% of the national Medicare Advantage market share, Centene’s Medicare Advantage plans are on par for acupuncture coverage. Unfortunately, Centene does not offer Medicare coverage beyond the CMS standards of 12 treatments for chronic low back pain.
Do Cigna Medicare plans pay for Acupuncture?
Cigna Medicare Advantage plan only cover acupuncture for chronic low back pain.
Do Highmark Medicare plans pay for Acupuncture?
Highmark Medicare Advantage plan only cover acupuncture for chronic low back pain.
Acupuncture Coverage Options When Medicare Denies Coverage?
Unless you have a Medicare covered chronic low back pain, you can expect to pay for acupuncture session out of pocket. Insurance coverage and acupuncture therapy can be a double-edged sword. On one side, the acupuncturist doesn’t accept health insurance, and the other side, the insurance company doesn’t cover the acupuncture therapy.
According to a study published by the National Institute of Health, that average cost of an acupuncture treatment is between $75 and $150. Most certified charge a initial visit fee that’s generally 1.5 to 2 times the cost of their regular fee.
One option is to see if your state offers any type of financial assistance for acupuncture treatments. For example, the state of California offers a program called the Acupuncture Medi-Cal Program, which provides free or low-cost treatments to low-income residents. Another option is to check with local community organizations or charities to see if they offer any type of financial assistance for acupuncture sessions.
Another option is to look into community acupuncture clinics. Community acupuncture clinics are typically lower cost than private practices because they offer treatments in a group setting. This means that acupuncturists can see more patients in a day, which lowers their overhead costs. To find a community acupuncture clinic in your area, you can search online or ask your local healthcare provider for recommendations.
Is Acupuncture Safe?
Acupuncture is a safe, painless form of treatment when performed by a trained practitioner. The needles used in acupuncture are very thin and solid; they are not hollow like hypodermic needles. The needles used in acupuncture are also much thinner than those used in injections or blood tests. In addition, acupuncture needles are not inserted deep into the skin like hypodermic needles; they are only inserted a few millimeters below the surface of the skin. As a result, acupuncture is considered a very low-risk form of treatment.
There is a growing body of evidence suggesting that acupuncture may be an effective treatment for conditions like headaches/migraines, joint pain/arthritis, chronic pain, digestive disorders, anxiety/depression, and insomnia. If you’re looking for an alternative form of treatment for any of these conditions, make sure to consult with a trained practitioner to see if acupuncture is right for you!
What Should You Expect During the First Acupuncture Session?
During your first acupuncture session, your Acupuncturist should ask you about your medical history and all current health conditions. They will also want to know about any medications you are actively taking, as well as any allergies. The acupuncturist evaluate your physical health to determine the best points for insertion. Once the acupuncture needles are inserted, it’s common to feel a slight tingling sensation. The needles will be left in for 20-30 minutes, during which time you’re expected to maintain a position of relaxation.
