Medicare covers acupuncture only in certain cases, but finding providers who meet the guidelines can be challenging.

Medicare covers acupuncture only in certain cases, but finding providers who meet the guidelines can be challenging.

Medicare coverage for acupuncture

In a positive development for Medicare patients, the Centers for Medicare and Medicaid Services (CMS) announced in January 2020 that Medicare would now cover acupuncture treatments for chronic low back pain. This change has been made with the aim of increasing access to alternatives to prescription opioids. CMS Principal Deputy Administrator of Operations and Policy Kimberly Brandt expressed the belief that covering acupuncture for chronic low back pain is in the best interest of Medicare patients.

Under the new guidelines, Medicare Part B will cover up to 12 acupuncture visits within a 90-day period for chronic low back pain. If patients show improvement during these initial 12 sessions, an additional eight sessions may be covered, allowing for a maximum of 20 acupuncture treatments in a 12-month period. The cost for each session would be the standard 20% of the Medicare-approved amount after meeting the Part B deductible.

What is chronic low back pain?

While many people experience low back pain from time to time, Medicare coverage for acupuncture specifically targets chronic low back pain. According to CMS, chronic low back pain is defined as pain that: – Lasts at least 12 weeks – Has no identifiable cause associated with a disease or infection – Is not associated with surgery or pregnancy

How does acupuncture treat low back pain?

Acupuncture has been shown to offer relief for a variety of health issues, but studies have particularly highlighted its effectiveness in treating low back pain. Research indicates that acupuncture provides short-term relief from chronic back pain and its benefits can continue for up to a year after treatment ends for many conditions. While the exact mechanisms of how acupuncture works for back pain are not completely understood, it is believed to directly influence the targeted tissue and release endorphins, which can alleviate pain.

Who can provide Medicare-covered acupuncture?

However, there is a challenge when it comes to accessing Medicare-covered acupuncture. Currently, licensed and degreed acupuncturists can only provide Medicare-covered acupuncture if they are supervised by an on-staff medical doctor (MD), physician assistant (PA), nurse practitioner (NP), or a clinical nurse specialist (CNS). This requirement poses difficulties as the majority of acupuncturists work independently and do not have such medical professionals on staff. This means that only a limited number of acupuncturists, around 1,000 nationwide, are able to offer services covered by Medicare.

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Efforts are being made to address this issue. Mori West, insurance committee chair of the American Society of Acupuncturists and CEO of ACUCLAIMS, has been communicating with CMS to find potential workarounds. Additionally, Representative Judy Chu (D-CA) introduced bill H.R.3133 – Acupuncture for Our Seniors Act of 2023. If passed, this bill would allow acupuncturists to be enrolled in Medicare and bill directly, removing the need for supervision.

Medicare Advantage coverage of acupuncture

Medicare Advantage plans mirror the acupuncture benefits of Medicare. Therefore, they offer the same coverage for chronic low back pain. However, providers offering Medicare-covered acupuncture under Medicare Advantage plans still need to have a medical doctor on staff.

Some Medicare Advantage plans may go beyond the basic coverage and provide routine acupuncture for various conditions, including chronic low back pain. These additional coverage options can differ among plans, so it’s important to review individual plan details.

Medicaid coverage for acupuncture

While Medicare has made progress in covering acupuncture, it’s worth noting that several states offer Medicaid coverage for this form of treatment. Washington, Oregon, California, New Mexico, Colorado, Minnesota, Missouri, Illinois, Ohio, Florida, New Jersey, New York, Massachusetts, Connecticut, and Maryland all provide Medicaid coverage for acupuncture. The extent of coverage varies by state, so it’s important for those interested in Medicaid coverage to check the specific rules and guidelines of their state.

Community acupuncture

For individuals seeking a more affordable form of acupuncture, community acupuncture may be a viable option. This new model of acupuncture, available in many parts of the country, offers a “pay what you can” or lower-cost approach to treatment. In community acupuncture clinics, a group of people sit in lounge chairs and receive acupuncture based on their specific health challenges. This alternative model is spearheaded by the People’s Organization of Community Acupuncture, a low-cost acupuncture training school. They also offer a directory of community acupuncture clinics, making it easier for individuals to find such services in their area.

In conclusion, the Medicare coverage for acupuncture marks a positive step forward in expanding access to alternative treatments for chronic low back pain. While there are challenges related to the supervision requirement for acupuncturists, efforts are being made to address this issue. Medicaid coverage for acupuncture is available in several states, and community acupuncture offers a more affordable option for those seeking treatment. Overall, these developments highlight the growing recognition and acceptance of acupuncture as a viable form of therapy within the healthcare system.