Is Acupuncture Covered Under Medicare

Acupuncture For Chronic Lower Back Pain A New Benefit For Some Medicare Advantage Members

In compliance with the National Coverage Determination requirements, ConnectiCare has begun to offer acupuncture for chronic lower back pain as a covered benefit for our Medicare Advantage members since Jan. 1, 2020. This is a benefit offered through our HMO, HMO-POS and HMO D-SNP plans.

Under the new benefit, covered services include up to 12 visits in 90 days for Medicare beneficiaries with chronic lower back, defined as:

• Lasting 12 weeks or longer,
• Nonspecific, in that it has no identifiable systemic cause ,
• Not associated with surgery, and
• Not associated with pregnancy

An additional eight sessions will be covered for patients demonstrating improvement. No more than 20 acupuncture treatments may be administered annually. Treatment must be discontinued if the patient is not improving or is regressing.

Preauthorization is required after the 12th visit.

Members will need to pay a $30 copay for each visit, unless they are members who are dual eligible for Medicare and Medicaid. Medicaid will pay the members cost-share if the dual-eligible members goes to a Medicaid approved provider. Please note, Qualified Medicare Beneficiaries cannot be billed.

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How Much Does Acupuncture Cost With Medicare

To find out how much your treatments will cost, you should talk to your health care provider and Medicare plan provider before scheduling your services. Your total costs may vary based on things like how much your health care provider charges, other insurance you may have, or whether your health care provider accepts assignment.

NOTE: Acupuncture coverage for cLBP was added to Medicare Part B plans as of January 21, 2020, and treatments completed prior to that date may not be covered.

Duration Of Acupuncture Treatment Covered By Medicare

Medicare Part B plans will cover up to 12 visits in 90 days for the treatment of chronic lower back pain, which meets the following criteria:

• Lasts 12 weeks or longer
• Cannot be the result of another condition, whether inflammatory, infectious or related to any other kind of disease
• Is not induced by post-surgery pain
• Is not caused by pregnancy

If a patient improves after 12 acupuncture sessions over the course of three months, Medicare Part B will cover another eight sessions for a total of up to 20 sessions in a year. The Centers for Medicare and Medicaid Services requires treatment to stop if the patient does not improve after this initial time frame.

If a patient improves after 12 acupuncture sessions over the course of three months, Medicare Part B will cover another eight sessions for a total of up to 20 sessions in a year.

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Does United Health Care Cover Acupuncture

United HealthCare , Aetna, Cigna, Horizon Blue Cross Blue Sheild of NJ, Empire Blue Cross Blue Sheild, Anthem Blue Cross Blue Shield, The Empire Plan / NYSHIP, Oxford, AmeriHealth, MagnaCare, QualCare, Oscar, and even many of the lesser known and smaller insurance companies now cover acupuncture as part of their medical healthcare services.

The Disadvantage Of Medicare Advantage Plans

In some situations, a Medicare Advantage plan may not be the best choice for you. For example, although the monthly premium might be lower than a Medigap plan, you could still end up paying more overall if you become ill and must pay copays or coinsurance more frequently.

If you have a Medicare Advantage plan that relies on smaller provider networks, you might also pay more to access the out-of-network care you need. And people in rural areas may struggle to access even more run-of-the-mill care, whereas Original Medicare recipients can go to any provider that accepts Medicare.

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Is Acupuncture Covered By Medicare

As of January 2020, Medicare covers acupuncture treatment for chronic low back pain, according to the Centers for Medicare & Medicaid Services.1 The coverage is subject to limitations on the number of sessions and the type of provider administering the treatment.2

Heres a deeper look into acupuncture and Medicare.

Do Any Medicare Supplement Plans Cover Acupuncture

Medicare Supplement Plans, also known as Medigap plans, do not cover acupuncture. However, there is one exception: Innovative Plan G in California. As a result, the majority of people with Medigap are only eligible for acupuncture for chronic lower back pain that is not cancer-related and not the result of infection or inflammatory disease.

To find a plan that covers acupuncture, use our Personal Shopper.

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Does Medicare Cover Acupuncture For Pain

Currently, Medicare covers acupuncture for lower back pain only. Medicare will not cover acupuncture for pain in other areas of the body. Additionally, if acupuncture covered by Medicare does not help with your lower back pain, Medicare will not authorize additional acupuncture treatments. To qualify, your lower back pain must meet specific requirements, including:

• No known cause the lower back pain is not a result of cancer or inflammatory or infectious disease
• Lasting for 12 weeks or longer
• Not associated with pregnancy or surgery

Attitudes Toward Acupuncture Changed In The Face Of A Rising Opioid Crisis

For the longest time, CMS viewed acupuncture as a sort of placebo treatment. Following the lead of American medical researchers, they saw no real benefit to acupuncture, and the treatment was primarily seen as a fad that created the illusion of a miracle cure for patients seeking fast, easy pain relief. As the 20th century came to an end, that attitude would slightly change.

Well, for much of the healthcare industry, at least.

In 1997, the National Institutes of Health conducted studies that showed acupuncture to be an effective treatment for not only chronic pain, but symptoms of other illnesses, diseases, and treatments as well. For example, it was viewed as highly effective for easing nausea in chemotherapy patients. Despite this research, CMS would not move from their position on the treatment, continuing to view it as ineffective and not medically necessary.

That is, until the issue of the opioid crisis would force CMS to budge. For decades, opioid medications were the primary go-to in Western medicine for pain relief. Despite research that proved opioids to be rather ineffective in treating chronic pain, many doctors continued prescribing these medications. As opioid use grew, so did the epidemic of opioid addiction.

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What Are Hmos And Ppos

HMOs are a type of health plan that only covers member costs if they go to medical providers that are part of their plans network.

PPOs also work as a network health plan, but will cover some of the costs if a member decides to use a medical provider that is not part of their network of preferred providers.

Depending on your provider, HMO and PPO Medicare Advantage plans might fully cover acupuncture if you use a provider in their network.

Otherwise, youll have to pay 20% of the costs like a Medicare beneficiary with Original Medicare.

Source: Pexels

Original Medicare And Acupuncture

Original Medicare is split into parts, which each cover specific services. Medicare Part A pays much of the cost of hospitalization and inpatient care, while Part D is the Medicare prescription drug benefit. Part B picks up much of the rest, including outpatient treatments such as acupuncture and other alternative treatments.

Part B, like the rest of Original Medicare, only provides coverage for treatments it deems medically necessary. Unfortunately, Original Medicare only authorizes acupuncture for lower back pain. Beneficiaries diagnosed with chronic back pain can get up to 12 acupuncture treatments in a 90-day period. Treatment can be extended by up to eight additional sessions if some improvement is shown. Original Medicare benefits are limited to a maximum of 20 sessions per year, or less if the condition worsens.

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How Can You Find A Licensed Acupuncturist

Medicare will only pay for acupuncture treatments done by a doctor or other health care provider such as a physician assistant or nurse practitioner. In addition to their medical education and license, they must also have two other qualifications:

There are several ways to find a licensed acupuncturist that meets Medicares requirements.

Finding a Licensed Acupuncturist

• Check with the your state agency that regulates acupuncture and acupuncturists.
• Use the Find a Practitioner tool at the National Certification Commission for Acupuncture and Oriental Medicine website to find a qualified acupuncturist in your area.
• If you have a Medicare Advantage plan, you may be able to find a qualified acupuncturist listed in the plans network of health care providers.

Alabama, Oklahoma and South Dakota do not have state licensing requirements for acupuncturists. But if you have Medicare Advantage, your insurer may still require you to seek a practitioner with state certification to stay within Medicares coverage rules.

What Will Acupuncture Cost If Medicare Covers Me

The price of acupuncture will vary based on your practitioner and your location. You can expect to pay anywhere between $50 to a few hundred dollars for different kinds of acupuncture treatments.

With Medicare coverage, you can use the general rules for Part B to determine how much you will pay for treatment.

Part B Medicare pays 80% of outpatient or non-hospital medical expenses and will cover acupuncture for chronic low back pain.

Medicare beneficiaries cover the remaining 20%, known as a coinsurance amount. For example, if your medically necessary acupuncture therapy costs $110 per session:

Just remember that you also have to pay an annual deductible for Part B coverage. This is the amount you have to pay before Medicare Part B covers your acupuncture. In 2022, the Part B deductible is $233.

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Does Medicare Pay For Acupuncture

Yes, Medicare does pay for acupuncture for certain conditions. Medicare Part B will provide some coverage for acupuncture in specific circumstances. In addition, Part C may provide more extensive acupuncture coverage, depending on your chosen plan. If you do not have acupuncture covered by Medicare with your Part C plan, you may have to pay the 20% coinsurance and deductible.

What Acupuncture Treatments Are Not Covered By Medicare

The new Medicare rule applies to acupuncture for chronic lower back pain. Theres no Medicare coverage for acupuncture to treat neck pain, headaches, stress, or relief from chemo. Medicare does NOT cover acupuncture to treat pain in other parts of the body.

Also, Medicare doesnt pay for acupuncture to treat temporary acute pain, such as pain from a recent injury. Further, it wont cover pregnancy-related lower back pain.

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Medicare Part C Eligibility

To enroll in a Medicare Part C plan, you must be eligible and meet specific requirements. You must:

• Be enrolled in Original Medicare, both Part A and Part B
• Live within the service area of the insurer and plan you are applying to enroll in
• The plan must be accepting new users.

You must also enroll in Medicare Part C during specific times.

Which Acupuncture Treatments Are Excluded From Coverage

While acupuncture can be a beneficial tool for pain and stress management, Medicare will not cover it to treat discomfort in other parts of the body, such as neck pain, headaches, stress, or relief from chemo. It also doesnt cover temporary acute conditions linked to injuries or pregnancy-related lower back discomfort.

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Does Medicare Cover Acupuncture Or Chiropractic

Learn if Original Medicare covers two popular alternative health treatments.

Chronic pain takes its toll on our ability to live a fulfilling life. With 52.9% of seniors 65 and older living in pain , finding alternative treatment for pain management is in high demand. Acupuncture and Chiropractic are the most utilized complementary care. Out-of-pocket costs for chiropractic and acupuncture can add up, so the question of the day is: does Original Medicare cover chiropractic and acupuncture?

Does Medicare Pay For Acupuncture And Physical Therapy

Medicare Part B will cover acupuncture for up to 12 sessions in 90 days, with an additional 8 sessions for beneficiaries who show improvement in their chronic lower back pain.

Medicare Part B can also help cover physical therapy.

Medicare no longer caps how much it will pay for physical therapy services in a single year, as long as your therapy services are deemed medically necessary by your therapy provider.

If your physical therapy or acupuncture is covered, Medicare Part B typically pays 80 percent of the Medicare approved amount, and you pay 20 percent after your Part B deductible is met. In 2022, the Medicare Part B deductible is $233 per year.

If your physical therapy or acupuncture is not deemed medically necessary by your therapist, Medicare will not cover the services, and you will be responsible for 100% of the costs.

Your therapist must give you written notice before providing services that are not medically necessary. From there, you can choose whether or not to accept the services and pay for them 100% out of pocket.

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Which Medicare Advantage Plans Offer Acupuncture

Medicare Advantage plans vary by location, not all plans offered are going to cover Acupuncture. But, Humana and UnitedHealthcare both offer plans in select areas with some acupuncture coverage. There may be other carriers that offer this benefit, but it really just depends on the plans available in your service area.

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We can help find the right Medicare plans for you today

Can You Claim Acupuncture On Medicare

On top of meeting specific qualifying conditions to be eligible for coverage with Medicare, your acupuncturist must be a general practitioner.

But your coverage depends on your policy. Medicare Advantage plans can be a little different.Further, lower back pain can have no known cause to qualify for coverage, such as inflammatory disease. Also, pain cannot be related to pregnancy or surgery.

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Finding A Medicare Advantage Plan That Covers Acupuncture

Since Medicare Advantage policies are provided by private insurers, Medicare Advantage plans vary from state to state, so the details of plans offered in Massachusetts are likely to differ from those available in California, Texas and Florida. In spite of this, Medicare Advantage plans do have some details in common. Most are organized as health maintenance organizations, preferred provider organizations, private fee-for-service or special needs plans. Some of these plans are more likely to cover alternative therapies than others, although it may take some research to find a state-specific plan that has the necessary coverage.

Why Medicare Advantage Plans Are Bad And Why Dont The Doctors Like Ma

While affordable Medicare Advantage plans are an increasingly popular choice for beneficiaries, not all doctors love the plans. Patients often do not have as much choice in the doctors they can see and may face hurdles to getting to the specialists they need for specific conditions.

Insurers providing affordable Medicare Advantage plans also pay doctors upfront based on the diagnosis of the patient. This method can be risky for the doctor, who can lose money if they do not stay within the budget. And the patient may not get the most appropriate care.

That is why it is very important to check if your preferred doctors are in the network of the Medicare Advantage plan that you are looking to enroll in. You can easily do that using this tool, just enter your zip code and your preferred doctors and check which plans are offered in your area by the top insurance carriers that include your doctors as part of their respective network.

Finally, prior authorizations can be just as frustrating for the doctors as it is for the patients.

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Medicare Advantage Plan: Acupuncture Coverage For Chronic Lower Back Pain

Since January 2020, the Centers for Medicare & Medicaid Services covers acupuncture only for Medicare patients with chronic Lower Back Pain .

Who may perform acupuncture for cLBP?

Physicians, in accordance with state requirements and physician assistants, nurse practitioners/clinical nurse specialists and auxiliary personnel who meet all applicable state requirements and have:

• A masters or doctoral degree in acupuncture or oriental medicine from a school accredited by the Accreditation Commission for Acupuncture and Oriental Medicine
• A current, full, active and unrestricted license to practice acupuncture in a state, territory or commonwealth of the United States, or in the District of Columbia

Read about state requirements in the Social Security Act 1861 Part E-Miscellaneous Provisions for physicians, physician assistants, nurse practitioners/clinical nurse specialists and auxiliary personnel.

Auxiliary personnel furnishing acupuncture must be under supervision of a physician, physician assistant or nurse practitioner/clinical nurse specialist.

Requirements are included in our .

CMS covers up to 12 visits in 90 days for cLBP when the pain:

• Lasts 12 weeks or longer
• Is not associated with surgery or pregnancy

• No more than 20 acupuncture treatments annually
• Treatment must stop if the patient not improving or regresses

When Does Medicare Cover Acupuncture

Find Cheap Medicare Plans in Your Area

Acupuncture is covered by two types of Medicare insurance plans Original Medicare and Medicare Advantage along with Medicare Supplement policies. Medicare limits the number of acupuncture sessions you can receive and who can provide those services.

When comparing how each option covers acupuncture, Medicare Advantage generally offers lower cost plans with the same or better coverage than Original Medicare. This makes Medicare Advantage plans particularly HMOs our choice for best overall value.

Medicare covers acupuncture only for chronic low back pain, which the agency defines as:

• Pain not associated with surgery or pregnancy
• Having no known cause
• Lasting 12 weeks or longer

You are covered for up to 12 acupuncture visits in 90 days. Medicare will cover eight additional sessions if you show improvement, which means you can receive up to 20 acupuncture treatments in a calendar year. If your doctor decides the treatment is not helping or your condition is getting worse, Medicare won’t cover the extra acupuncture services.

Remember that Medicare doesn’t cover acupuncture for any condition other than chronic low back pain.

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