Acupuncture is the application of small, thin needles to strategic areas in the body to relieve pain and restore energy flow. In 2020, Medicare began covering acupuncture as a treatment for lower back pain.
According to the National Center for Complementary and Integrative Health (NCCIH), acupuncture can help soothe neck and lower back pain, as well as discomfort due to osteoarthritis and knee pain.
People might also benefit from the effects of acupuncture if they have migraine headaches.
At present, Medicare funds up to 12 sessions of acupuncture treatment for those with chronic lower back pain. The insured individual will need to pay 20% of the fee that Medicare approves for cover, as Part B accounts for acupuncture, and coinsurance applies.
A person must receive these 12 treatment sessions within a 90-day window.
Coverage for further sessions is available for those with chronic pain whose symptoms improve after the first 12 sessions.
In this article, we discuss Medicare’s coverage of acupuncture for back pain, other Medicare-approved back pain treatments, and how acupuncture works.
On January 21, 2020, the Centers for Medicare & Medicaid Services (CMS) announced that they would cover acupuncture services to help treat chronic lower back pain.
Previously, Medicare did not cover acupuncture to treat any condition. Medicare Part B is the portion that would cover these treatments, as this accounts for nonhospital medical treatments.
The new ruling provides Medicare coverage for up to 12 sessions in a 90-day period, with the possibility of an additional eight sessions should a person experience an improvement in their symptoms.
Medicare will only cover up to 20 sessions in a 12-month period, based on available research about the lasting effects of acupuncture treatments.
For Medicare to cover acupuncture, the person administering it must be either:
- a doctor
- a physician’s assistant
- a nurse practitioner
- a healthcare professional with master’s or doctorate level training in acupuncture and a state license to practice acupuncture.
Medicare has put improved acupuncture coverage in place as part of a growing effort to help people access nonopioid pain management.
According to a press release announcing the decision to expand acupuncture coverage, the CMS reviewed several studies that supported the use of acupuncture in treating lower back pain.
Medicare Advantage is an alternative to traditional Medicare. An insured person pays a private insurance company for parts A, B, and D. This coverage includes hospital care, medical care, and prescription drugs.
Some people choose Medicare Advantage policies because these also cover additional services, such as dental or eye care.
Medicare Advantage plans provide the same level of cover as traditional Medicare, including the same procedures and medical treatments. Therefore, Medicare Advantage will also cover acupuncture for lower back pain.
However, some Medicare Advantage plans may expand acupuncture coverage to treat other conditions. A deductible and copayment may still apply.
Many Medicare Advantage plans require a person to choose healthcare providers from within a limited network. This requirement may extend to acupuncture professionals.
Other Medicare Advantage plans require a physician to refer a person to an acupuncture professional before Medicare covers the costs.
People with a Medicare Advantage plan may wish to contact their insurance provider for a list of in-network healthcare professionals and clarification on their level of acupuncture coverage.
Acupuncture is a traditional Chinese medicine practice that people have used for thousands of years to relieve pain and promote wellness. To perform acupuncture, a professional applies needles to specific areas on the body as a means of inducing energy flow and relieving pain.
This process can trigger the release of pain-relieving chemicals that occur naturally in the body, according to an article in The Journal of Alternative and Complementary Medicine. Imaging studies of people’s brains when they receive acupuncture also found that acupuncture helps “quiet down” overactive pain sensors.
The effects of acupuncture on chronic pain can be long lasting, according to an article in the journal Pain. In a review of 29 clinical trials involving people with headache or pain in the lower back, neck, shoulder, or knee, an estimated 90% of the 17,922 participants reported that pain relief lasted at least 12 months after their acupuncture treatments.
In addition, acupuncture does not usually cause significant side effects. The most common adverse effects are pain and bleeding at the needle insertion site.
Acupuncture professionals use acupuncture to treat a variety of medical conditions. The authors of a 2019 article in The Journal of Alternative and Complementary Medicine estimated that 37,000 licensed acupuncturists currently practice in the United States.
According to the American Academy of Medical Acupuncture, acupuncture can help relieve symptoms of the following conditions:
- blood pressure problems
- chronic fatigue
- knee pain
- menopausal symptoms
- neck pain
- premenstrual syndrome (PMS) symptoms
However, for many of these conditions, there is not a significant body of research to support acupuncture as an effective treatment.
Although practitioners may use acupuncture to treat other conditions, Medicare will only cover its use in the treatment of lower back pain.
Medicare does not cover some services to treat back pain, such as massage therapy. However, Medicare does cover some services that address back pain, including the following:
Medicare covers chiropractic services when they treat subluxation. Subluxation is when a misalignment of the spinal bones places extra strain or pressure on the nerves in the back, causing pain.
Medicare Part B covers chiropractic care for subluxation up to an approved amount. The Part B deductible applies alongside the standard 20% coinsurance.
Medicare pays for medically necessary physical therapy on an outpatient basis.
A doctor may recommend physical therapy to strengthen and stretch the back muscles to reduce tension and pain. The Part B deductible and coinsurance apply.
Medicare does not cover some back pain treatments, such as:
- massage therapy
- cold laser therapy
- chiropractic treatments that do not involve spinal manipulation
Acupuncture is an example of how Medicare sometimes expands coverage to treat some conditions in response to the research.
At present, chronic lower back pain is the only approved condition for acupuncture treatment. However, a person can now use the service with a higher level of coverage than before.
If a person has Medicare Advantage, they should check their plan to identify in-network providers and to determine whether they need a doctor’s referral to seek acupuncture treatment.
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