Acupuncture is the practice of applying tiny needles to specific 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
People might also benefit from the effects of acupuncture if they have migraine headaches.
Medicare currently 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.
With this program, a person can receive up to 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.
This article explores 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 it would cover acupuncture services to help treat chronic lower back pain.
The new ruling provides Medicare coverage for up to 12 sessions in a 90-day period, with the possibility of an additional eight sessions if a person experiences an improvement in their symptoms.
However, Medicare will only cover up to 20 sessions across a 12-month period, based on available research about the lasting effects of acupuncture treatments.
For the program to cover acupuncture, the practitioner must be a doctor. Alternatively, a physician’s assistant, nurse practitioner, or healthcare professional can administer this treatment, as long as they have master’s or doctorate level training in acupuncture and a state license to practice acupuncture.
Medicare has implemented improved acupuncture coverage as part of a growing effort to help people access nonopioid pain management.
According to a press release announcing the decision to expand coverage for this technique, the CMS reviewed several studies that supported using acupuncture in treating lower back pain.
When making an appointment for acupuncture, a person should check the acupuncturist is eligible to bill Medicare.
To bill Medicare, the practitioner administering it must be a doctor, physician’s assistant, or nurse practitioner and have master’s or doctorate level training in acupuncture and a state license to practice acupuncture. This means they must have a dual license.
Many acupuncturists have master’s or doctorate level training in acupuncture and a state license to practice acupuncture but are not physicians, physician’s assistants, or nurse practitioners. Therefore, they are not eligible to bill Medicare.
Medicare Advantage is an alternative to traditional Medicare. A person with this plan pays a private insurance company for parts A, B, and D. This coverage includes hospital care, medical care, and prescription drugs. Some people choose these policies as they also cover additional services, such as dental or eye care.
Medicare Advantage plans provide the same level of coverage as traditional Medicare, including the same procedures and medical treatments. Therefore, the program 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 of these plans require a person to choose healthcare professionals from a limited network, a requirement that may extend to acupuncture professionals. Other plans require a physician to refer individuals 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 practitioners have used for thousands of years to relieve pain and promote wellness. To perform the technique, a trained professional applies tiny needles to specific areas of the body to induce energy flow and relieve pain.
This process can trigger the release of pain-relieving chemicals that occur naturally in the body. Imaging studies of people’s brains when they receive acupuncture have found that the method helps “quiet down” overactive pain sensors.
The effects of acupuncture on chronic pain can be long lasting. In a review of 29 clinical trials involving people with headaches or pain in the lower back, neck, shoulder, or knee, an estimated
In addition, the technique does not usually cause significant side effects, the most common being 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 estimated that around 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:
However, there is not a significant body of research to support acupuncture as an effective treatment for many of these conditions. Although practitioners may use the technique to treat other conditions, Medicare will only cover its use to treat lower back pain.
Medicare does not cover some services to treat back pain, such as massage therapy. However, it does cover some services that address back pain, including the below.
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, including:
Acupuncture is one example of how Medicare sometimes expands coverage to treat some conditions in response to research.
At present, chronic lower back pain is the only Medicare-approved condition for acupuncture treatment. However, a person can now use the service with a higher level of coverage than before.
If an individual has Medicare Advantage, they can check their plan to identify in-network providers and determine whether they need a doctor’s referral to seek acupuncture treatment.