Does Medicare Cover Acupuncture Costs?
Medicare began covering acupuncture in January 2020, but only for chronic lower back pain. Medicare Part B covers up to 12 acupuncture visits in 90 days for beneficiaries with the condition. Original Medicare — Part A and Part B — does not cover acupuncture treatments for any other condition.
What Is Acupuncture?
Acupuncture is a major part of traditional Chinese medicine most commonly used to treat pain.
An acupuncturist inserts extremely thin needles through the skin into strategically selected points in your body.
Traditional Chinese explanations of how acupuncture works focus on the technique of balancing the flow of your life force, or chi, through pathways in your body. Western practitioners believe that it works by stimulating nerves, muscles and other tissues in your body.
- Dental pain
- Lower back pain
- Menstrual cramps
- Migraines and other headaches
- Nausea and vomiting associated with chemotherapy or surgery
- Neck pain
- Pain associated with labor
- Respiratory disorders
Why Did Medicare Start Covering Acupuncture?
Medicare did not cover any acupuncture procedures until Jan. 21, 2020. The decision to provide limited acupuncture coverage followed reviews of medical evidence and studies.
There have been few studies of acupuncture’s benefits for people 65 and older, the demographic of most Medicare beneficiaries.
But a review of what research there is found that acupuncture appears to improve function and reduce pain in older patients with chronic lower back pain.
The decision was also fueled in part by the opioid crisis that grew out of the overprescribing of prescription opioids to treat pain, which led to a nationwide addiction problem. The federal government had been looking for alternatives to the drugs for pain management.
When Does Medicare Pay for Acupuncture?
Medicare Part B will only pay for acupuncture treatments to treat chronic back pain.
- Back pain lasting 12 weeks or longer.
- Back pain that has no identifiable systemic cause — the pain cannot be associated with metastatic, inflammatory or infectious diseases.
- Back pain that is not associated with pregnancy or surgery.
If the pain meets Medicare’s criteria, Medicare Part B will pay for up to 12 acupuncture sessions in 90 days. If you show improvement, Medicare will pay for an additional eight treatments. But it will not pay for more than 20 acupuncture visits per year.
Medicare Advantage plans may offer additional acupuncture coverage. You should check with your plan’s administrator to determine exactly what it will cover.
How Can You Find a Licensed Acupuncturist?
Medicare will only pay for acupuncture treatments done by a doctor or other health care provider such as a physician assistant or nurse practitioner. In addition to their medical education and license, they must also have two other qualifications:
- A masters or doctorate level degree in acupuncture or traditional Asian Medicine from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine.
- A “current, full, active and unrestricted” license to practice acupuncture in the state where the treatments take place.
There are several ways to find a licensed acupuncturist that meets Medicare’s requirements.
- Check with the your state agency that regulates acupuncture and acupuncturists.
- Use the Find a Practitioner tool at the National Certification Commission for Acupuncture and Oriental Medicine website to find a qualified acupuncturist in your area.
- If you have a Medicare Advantage plan, you may be able to find a qualified acupuncturist listed in the plan’s network of health care providers.
Alabama, Oklahoma and South Dakota do not have state licensing requirements for acupuncturists. But if you have Medicare Advantage, your insurer may still require you to seek a practitioner with state certification to stay within Medicare’s coverage rules.
6 Cited Research Articles
- Medical News Today. (2020, March 12). Does Medicare Cover Acupuncture? Retrieved from https://www.medicalnewstoday.com/articles/does-medicare-cover-acupuncture
- Jefferson, R.S. (2020, January 24). Medicare Will Now Pay for Acupuncture in Part Due to Opioid Abuse. Retrieved from https://www.forbes.com/sites/robinseatonjefferson/2020/01/24/medicare-will-now-pay-for-acupuncture-in-part-due-to-opioid-abuse/#7a1ce3ea378a
- U.S. Centers for Medicare & Medicaid Services. (2020, January 21). CMS Finalizes Decision to Cover Acupuncture for Chronic Low Back Pain for Medicare Beneficiaries. Retrieved from https://www.cms.gov/newsroom/press-releases/cms-finalizes-decision-cover-acupuncture-chronic-low-back-pain-medicare-beneficiaries
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Acupuncture. Retrieved from https://www.medicare.gov/coverage/acupuncture
- Mayo Clinic. (n.d.). Acupuncture. Retrieved from https://www.mayoclinic.org/tests-procedures/acupuncture/about/pac-20392763
- National Certification Commission for Acupuncture and Oriental Medicine. (n.d.). NCCAOM Find a Practitioner Directory. Retrieved from https://www.nccaom.org/find-a-practitioner-directory/