Acupuncture is a therapeutic technique that originates from traditional Chinese medicine. Practitioners can use it to help clients treat a variety of physical conditions and their symptoms, including illness and chronic pain. It involves the insertion, manipulation and removal of small needles through your skin across several particular parts of your body to stimulate connective tissues, nerves and muscles.
If you have Original Medicare coverage, you may be able to use it to help pay for acupuncture treatments, although it depends on your unique needs. For example, Original Medicare, specifically Part B, will cover acupuncture, but only for chronic low back pain.
In order to receive Original Medicare coverage, acupuncture must be performed by a licensed healthcare provider with a degree in acupuncture or Oriental Medicine from an accredited school. In this article, we’ll explore coverage rules for acupuncture under Medicare Part B and discuss whether or not Medicare Advantage plans also cover acupuncture.
Conditions for Acupuncture Coverage Under Medicare Part B
In order for Medicare Part B to cover acupuncture appointments for lower back pain, it must meet a variety of conditions, including the duration of the treatment and its effectiveness. It’s also important to consider how Medicare Part B defines chronic low back pain: a pain lasting 12 weeks or longer that doesn’t have an identifiable cause and isn’t associated with circumstances like surgery or pregnancy.
Here’s what you’ll need to keep in mind when seeking acupuncture coverage with Original Medicare:
The treatment must be ordered as medically necessary by a healthcare provider
Part B covers up to 12 acupuncture visits in 90 days for chronic low back pain.
It will cover an additional 8 sessions if you show improvement. If you aren’t showing improvement, Medicare Part B won’t cover additional sessions.
Beneficiaries can get a maximum of 20 acupuncture treatments in a 12-month period for low back pain.
It’s also important to keep in mind that for acupuncture to be covered by Original Medicare, it must be administered by a health care provider who has:
A masters or doctoral degree in acupuncture or Oriental Medicine from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine
A current, full, active and unrestricted license to practice acupuncture in the state where you’re seeking care
Do Medicare Advantage plans cover acupuncture?
Since Medicare Advantage must provide the same benefits as Original Medicare, these plans will offer the same coverage for acupuncture as Medicare Part B. Some Medicare Advantage plans may offer additional coverage, but it's important to review the details of your specific plan to determine what is covered.
You’ll want to keep in mind that Medicare Advantage plans vary in cost and coverage, so it’s best to review your personal plan details when trying to find out about specific benefits.
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