Acupuncture is a healing method for physical ailments that originated in East Asia over 2,000 years ago. It stimulates specific points on the body with very fine needles, heat, or pressure, which revitalizes nerves and balances the flow of energy to treat pain and nausea and reduce inflammation.
If you’re managing chronic pain, you may wonder if acupuncture treatments can help. Additionally, if you’re a Medicare beneficiary, you may be interested in whether Medicare covers acupuncture treatments.
Does Medicare Cover Acupuncture?
As of January 2020 Medicare plans cover acupuncture treatments. As a result, Medicare covers acupuncture only as a treatment for chronic low back pain. CMS recognizes acupuncture practitioners who are doctors, nurses, or other health providers with:
- A master’s or doctoral degree in acupuncture from a school accredited by the Accreditation Commission On Acupuncture and Herbal Medicine.
- A current, full, active, and unrestricted license to practice acupuncture in the state where you’ll receive care.
Original Medicare
Original Medicare comprises Part A, hospital care, and Part B, medical and outpatient care. If you have chronic back pain, Medicare Part B covers up to 12 acupuncture visits in 90 days. For patients who show improvement, Medicare covers 8 additional sessions, for up to 20 treatments per year. However, it does not cover additional treatments for patients whose pain worsens or does not improve.
After meeting your Part B deductible, you pay 20% of the Medicare-approved amount for the treatment. Your insurance pays the other 80%.
Medicare Advantage
Medicare Advantage is a health plan offered by a private insurer that contracts with Medicare. It includes both Medicare Parts A and B, and often Part D, prescription drug coverage.
Because Medicare Advantage plans are required to have the same benefits as Original Medicare, they cover acupuncture treatments in the same capacity as Original Medicare. However, some insurers may also cover acupuncture treatment for reasons beyond lower back pain, such as nausea or general chronic pain.
If you’re enrolled in a Medicare Advantage HMO, your treatment might require pre-authorization or a referral from your primary physician, and you’ll likely need to find an acupuncturist who is in-network.
While insurance covers most of the cost, you may pay a copay between $10-to-$35 per visit, depending on your provider.
Medigap/Medicare Supplement
Like Medicare Advantage, Medigap is Medicare Supplement Insurance sold by private companies to cover out-of-pocket Medicare costs like deductibles, coinsurance, and copays. After you meet your deductible, Medigap covers your portion of the costs for Original Medicare Part A or Part B services. Medigap cannot be used with Medicare Advantage.
For acupuncture, after meeting your deductible, you pay 20% of the cost. Your Medigap plan plays some or all of that cost.
Benefits of Acupuncture
Acupuncture involves inserting very thin needles into the skin to stimulate specific points of the body. This technique balances the body’s energy flow, or chi (also knowns as qi), according to traditional Chinese medicine. Western practitioners see acupuncture points as stimulating muscles, nerves, and connective tissue, which boosts the body’s natural ability to fight pain.
Patients often seek acupuncture treatments for chronic pain such as arthritis, back, neck and knee pain, headaches, menstrual cramps, and nausea.
CMS cites a study on the effect of acupuncture in relieving low back pain in adults 65 or older in its announcement to cover acupuncture for Medicare beneficiaries. Older adults benefit from acupuncture as it allows them to reduce or eliminate prescription drugs taken to manage pain and avoid the side effects of medication.
What Is Included In Medicare Coverage of Acupuncture?
To gain coverage under medicare, acupuncture treatment can only be prescribed for chronic lower back pain.
Medicare defines lower back pain as:
- Lasting at least 12 weeks
- Not caused by cancer, inflammatory or infectious disease
- Not associated with surgery or pregnancy
What Is Excluded in Medicare Coverage of Acupuncture?
People seek acupuncture treatments for chronic pain and other health issues. However, Medicare doesn’t cover acupuncture for conditions such as:
- Neck or muscle pain
- Headaches and migraines
- Arthritis
- Cancer and side effects like nausea from cancer treatment
While studies show acupuncture effectively treats conditions like migraines and nausea, CMS will not approve treatments without sufficient evidence of their effectiveness. Because Medicare will not cover these treatments, you may have to pay out of pocket for acupuncture for pain caused by other conditions.
What Do Acupuncture Services Cost?
If you receive acupuncture treatments, after meeting the $226 deductible for Medicare Part B, you’ll pay 20% of the Medicare-approved amount. Costs will vary based on where you live and what coverage you choose.
If you’re paying without Medicare, a study of acupuncture costs in the U.S. found a median price of acupuncture to be $112 for first visits and $80 for follow-up treatments. However, prices vary significantly, as the cost of a first-time visit was between $15-$400, while the range for follow-up visits was $15-$300.
Does Medicare Cover Other Pain Management Services?
Medicare covers treatments beyond acupuncture to provide drug-free approaches to managing chronic pain, such as physical therapy and chiropractic services.
Physical Therapy
Physical therapy uses exercise, massage, and cold or heat therapy to treat pain or injuries. It’s used to ease pain, improve mobility, recover from sports injuries, and rehabilitate the body after a stroke or surgery.
Your doctor or health care provider must certify that you need physical therapy, and Medicare Part B will cover those services. You may pay 20% of the cost of treatment after meeting your deductible, and Medigap may cover the remainder.
Chiropractic
A chiropractic adjustment involves manual therapy to press, stretch, and adjust the spine into the proper position. Medicare Part B covers chiropractic services to correct a subluxation or misalignment of the spinal vertebrae. After the Part B deductible, you (or Medigap) cover 20% of the cost of treatment.
Medicare does not cover services a chiropractor orders, like X-rays or massage therapy.