Medicare and Acupuncture

Does Medicare Cover Acupuncture Now?

As recently as December of 2019, acupuncture was not a treatment covered by Medicare in any shape or form. It was only in late January of 2020 that the Centers for Medicare & Medicaid Services (CMS) ruled that acupuncture could finally be covered, but only for patients with chronic lower back pain. 

This comes on the heels of recent efforts to curb opioid dependency and abuse in healthcare, with acupuncture among those non-medicated treatments that could go toward pain management plans for those suffering from chronic conditions. 

What IS Acupuncture, Exactly? 

Acupuncture is a form of alternative medicine that involves stimulating specific areas of the body, usually by inserting hair-thin needles. Pain relief is the most often cited reason for seeking acupuncture treatments, but there are others, such as sleep issues, smoking cessation, PTSD, and more. 

CMS bases its decision on bodies of data that showed its efficacy in treating patients with chronic lower back pain, several of which included patients aged 65 and older like the average Medicare recipient. While most of the data on acupuncture shows that it does not widely show long term effects, most pain management programs are about managing conditions that are not going to be cured, so the long term is less of a factor in deciding its effectiveness. 

Medicare and Acupuncture: The Requirements for Coverage

Coverage for acupuncture by Medicare includes a number of stipulations as to how it is to be used, including:

• Treatment is only approved for chronic lower back pain, which has lasted 12 weeks or longer, has no underlying causes like metastatic, inflammatory, or infectious disease, and is not associated with pregnancy or surgery. 
• Medicare will cover 12 sessions in a 90-day period, with a possible 8 additional sessions if the patient shows improvement. However, no more than 20 sessions will be covered yearly. 
• Medicare will cease covering sessions if your doctor reports no improvement or that your condition is getting worse. 

Furthermore, your treatment must be administered by a doctor or other medical professional with a full and unrestricted license to practice acupuncture, as well as either a masters degree or doctorate in acupuncture or Oriental Medicine from an institution accredited by the Accreditation Commission on Acupuncture and Oriental Medicine. 

Do you have questions about your Medicare coverage or available Medicare plans in your area. Consult with a professional for no charge through New Jersey Medicare Brokers. These dedicated agents are versed in all current Medicare policies, including recent decisions regarding Medicare and acupuncture.