Understanding Medicare and Acupuncture
Acupuncture is an alternative treatment used to treat health issues such as chronic pain.
Acupuncture treatment is associated with helping manage various conditions.
Medicare began covering acupuncture in 2020. Medicare only covers acupuncture for chronic low back pain, however.
There are other options available for pain management that are covered by Medicare.
Medicare patients struggling with health issues such as chronic pain may be interested in alternative medicine to find relief. One such route they may consider is acupuncture. However, is acupuncture covered under Medicare?
In the case of chronic low back pain, Medicare covers acupuncture, but only for a limited amount of sessions and only from a doctor or healthcare provider with set qualifications in acupuncture or oriental medicine.
As well, what is defined as chronic lower back pain is highly specific. No other conditions besides chronic back pain are covered by Medicare when it comes to acupuncture treatments.
What is Acupuncture?
Acupuncture is a traditional Chinese medical treatment. Acupuncture works by penetrating the skin with thin needles to treat pain and other health problems. The needles are inserted into specific points of the body, known as acupuncture points.
Acupuncture points are connected by meridians, or pathways, that allow energy (qi) to flow uninterrupted. According to traditional Chinese medicine, disruptions in the body’s qi are thought to be what causes disease and other ailments. As such, improving the qi flow is believed to improve one’s overall health.
Furthermore, acupuncture points are believed to stimulate the central nervous system. This stimulation then releases chemicals into the brain, spinal cord, and muscles, potentially triggering the body’s natural healing mechanisms. This may help improve physical and emotional wellness.
Potential Benefits of Acupuncture
Current studies have shown that acupuncture may help manage some pain conditions, especially in regards to back, knee, and neck pain, as well as headaches and migraines. However, research is still rather limited as far as its effectiveness goes in regard to other health problems.
Despite these research limitations, however, the American Academy of Medical Acupuncture states that acupuncture can also:
Reduce pain and other side effects from cancer treatments
Aid those seeking to quit smoking
Act as a complementary treatment for diabetes
Treat allergies
Lessen depression, anxiety, and insomnia symptoms
Does Medicare Cover Acupuncture?
As of January 21st, 2020, the Centers for Medicare & Medicaid Services (CMS) stated the federal Medicare program would cover acupuncture, specifically in regard to low back pain. This decision was based on efforts from the federal government to reduce opioid abuse in the United States. By covering acupuncture, the thought was that acupuncture could provide other options besides prescription opioids to treat chronic low back pain.
However, some stipulations must apply in order for acupuncture treatments to be covered in this scenario. In addition, only chronic lower back pain is covered.
Does Original Medicare Pay for Acupuncture?
Acupuncture is covered under Medicare Part B, the medical insurance portion of Original Medicare.
Medicare Part B only covers acupuncture in cases of chronic lower back pain. If this is the case, Medicare Part B covers up to 12 sessions of acupuncture in a 90-day period. However, Medicare will cover an additional eight sessions of acupuncture if improvement is seen. If the doctor determines chronic lower back pain isn’t getting better or is getting worse, Medicare will then not cover any additional acupuncture treatments.
In any event, coverage will not surpass more than 20 acupuncture treatments in a given year.
Does Medicare Advantage Cover Acupuncture?
A Medicare Advantage Plan, or Medicare Part C, is Medicare coverage through a private insurer. It provides coverage for Medicare Part A and Medicare Part B. It also covers Medicare Part D, prescription drug coverage.
Medicare Part C will have the same level of coverage levels as Original Medicare, meaning that the same qualifications for acupuncture coverage apply for those with this Medicare plan.
That said, some Medicare Advantage plans may include acupuncture coverage for other health issues besides chronic back pain. Medicare beneficiaries should contact their insurance provider to understand their coverage for their specific plan and situation.
Does Medicare Supplement Insurance Cover Acupuncture?
Medicare supplement insurance plans, also known as Medigap, are Medicare plans that work alongside Original Medicare to help fill in any gaps in health coverage. Medigap plans do not cover acupuncture.
Acupuncture Costs
According to the official Medicare website, cost details are not yet available for this particular Medicare benefit.
Medicare And Acupuncture for Chronic Low Back Pain: What Qualifies?
The following must be true in order for Medicare to define a condition as chronic lower back pain:
Symptoms must be present for 12 weeks or more
No identifiable systemic cause (i.e. cannot be related to metastatic cancer, inflammatory, or infectious disease)
Pain not associated with surgery or pregnancy
Necessary Qualifications of Acupuncture Practitioners
Acupuncture must be administered by a doctor, physician assistant, nurse practitioner, or by another health care provider who has the following qualifications:
A master’s or doctoral acupuncture degree from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine; an Oriental Medicine degree at the masters or doctorate level is also accepted
An active and unrestricted license to practice acupuncture in the state where care is being administered
Other Options for Pain Management Covered by Medicare
There are other options for pain management covered by Medicare, including:
Physical therapy
Occupational therapy
Chiropractic care
Summary
Patients with chronic health issues may seek alternative treatments to find pain relief. One such treatment is acupuncture. The question, then, is whether Medicare covers it. Medicare covers acupuncture under certain conditions.
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