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Does Medicare cover acupuncture?


No, with one exception.

Medicare Part B covers acupuncture only for enrollees with chronic lower back pain. If you’ve experienced low back pain for at least 12 weeks and the pain is not associated with another cause, such as cancer that has spread, inflammatory or infectious disease, surgery or pregnancy, you’re entitled to 12 acupuncture sessions within a 90-day period.

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Medicare may pay for up to eight additional sessions if your pain decreases as a result of acupuncture, but it sets a maximum at 20 sessions a year. If your chronic back pain doesn’t improve with acupuncture during the first 12 visits, Medicare won’t cover additional treatments.

Acupuncture involves stimulating the central nervous system through specific points on the body, usually by inserting needles into the skin and using gentle movements to alleviate pain. Until January 2020, Medicare didn’t cover acupuncture under any circumstances. The Centers for Medicare & Medicaid Services changed the rules in part to offer an alternative to opioids for lower back pain.

But this condition is the only exception. Medicare also won’t cover most other forms of alternative medicine with the exception of chiropractic care for medically necessary spinal manipulation.

What providers qualify for acupuncture coverage?

To qualify for coverage, the acupuncture must be administered by a doctor or other health care provider, such as a nurse practitioner or physician assistant, who meet both of these criteria:

  • A master’s or doctoral level degree in acupuncture or Oriental medicine from a school that has accreditation from the Accreditation Commission on Acupuncture and Oriental Medicine.
  • A current, full, active and unrestricted license to practice acupuncture in the state or territory where you’re receiving care.

How much do I pay for Medicare-covered acupuncture?

After you’ve met your annual Medicare Part B deductible, which is $233 in 2022 (and $226 in 2023), you’ll pay 20 percent of the Medicare-approved amount for the eligible acupuncture sessions.

You can buy a private Medicare supplemental policy to help cover Medicare’s deductibles, copayments and coinsurance. All Medigap policies cover the 20 percent Part B coinsurance in part or full.

Keep in mind 

If you have a private Medicare Advantage plan, rather than original Medicare, you may have broader coverage for acupuncture. Some Medicare Advantage plans cover acupuncture for pain in other parts of the body in addition to the lower back.

Ask your plan about its rules for acupuncture coverage. You may have a copayment for each visit, such as $20 a visit, and you may need to see a provider in your plan’s network.

Updated October 5, 2022

     

        

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