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  • Writer's pictureChristina

Medicare and Acupuncture

Active senior couple doing yoga

A question I get asked almost daily is "Does Medicare cover acupuncture?" and the answer is Yes... but it is tricky.

In 2020 Medicare announced that it would start covering acupuncture treatment with some limitations:

  • Acupuncture is currently covered for treatment of chronic low back pain only and no other illnesses or disorders. "Chronic" is defined as lasting 12 weeks or more.

  • Patients would receive 12 visits per year to be used over a span of 90 days, plus a potential extra 8 visits after a medical review if the therapy was shown to be helping their condition improve. So a maximum of 20 visits per year.

  • Acupuncture treatments need to be provided either by a physician who also provides acupuncture in their office, or by a licensed acupuncturist working under the supervision of a medical doctor, usually in their office or treatment facility.

At first glance, this sounds excellent! And in fact it is. This is a huge step for Medicare to begin covering acupuncture at all, for any reason. Chronic low back pain is one of the most common complaints as we age, and there is quite a bit of scientific evidence to show acupuncture being an effective and safe treatment. Hopefully this is just the beginning and Medicare will begin to cover acupuncture for a wider range of complaints in the future.

Now for the not-so-good news though: it is hard to find an office where you can receive acupuncture from a physician or an acupuncturist employed by their office. This is one of the stipulations for Medicare to cover acupuncture treatments. Unfortunately licensed acupuncturists in private practice (including yours truly and more than 90% of acupuncturists practicing in the state of New York) are not able to bill Medicare for the treatments we provide. Frustrating? Absolutely. Will this change in the future? Probably because right now this means that most Medicare patients are not able to take advantage of a benefit that they would love to receive, but I know that doesn't help you now.

Right now I would suggest that any Medicare patients looking to take advantage of this benefit should ask their doctor if they have a referral or recommendation to a pain management doctor who provides acupuncture and accepts Medicare. Remember, this still wouldn't be covered if you wanted to be treated for knee pain, insomnia, or tennis elbow for example (all of which respond so well to acupuncture!) - just chronic low back pain. If you have a secondary health insurance plan, it is possible that they might cover acupuncture treatments. If you wanted to be seen at our office we would provide you with a superbill to submit directly to the secondary insurance to see if they will reimburse you for your sessions.

As always, if you have any questions please give our office a call. We'd love to be able to help you if we can. But hopefully this post clears up some of the misconceptions regarding Medicare coverage and acupuncture, as of August 2021. Fingers crossed that I am writing an entirely different and entirely more positive blog post a year from now!



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