Introduction
Over the past few decades, acupuncture has gained considerable recognition as an effective treatment for various medical conditions. This shift in perspective has prompted changes in healthcare policies, including Medicare’s decision to cover acupuncture treatments. Are you interested in the history, rules, and guidelines surrounding Medicare coverage for acupuncture? If so, read on.
The History of Medicare Coverage for Acupuncture
Historically, Medicare, the health insurance for people 65 or older, did not include acupuncture treatments as a covered benefit. However, on January 21, 2020, the Centers for Medicare & Medicaid Services (CMS) announced that Medicare would begin covering acupuncture for chronic low back pain. This decision marked a significant shift in access to acupuncture for Medicare beneficiaries, although the new rules created restrictions limiting the number of eligible providers.
Criteria for Medicare Acupuncture Coverage
Several times a week, we at Metro Acupuncture receive calls from Medicare beneficiaries in Georgia who want to know if acupuncture is a covered benefit. To clarify the details of this benefit, we have outlined the guidelines below.
To qualify for Medicare coverage, acupuncture treatments must meet specific criteria:
Condition Coverage: Currently, Medicare covers acupuncture only for chronic low back pain. Chronic low back pain is defined as pain lasting 12 weeks or longer that is not due to identifiable systemic causes such as cancer, infection, or inflammatory disease.
Qualified Practitioners: The treatments must be performed by a licensed physician (MD or DO) or a licensed acupuncturist who meets specific qualifications. Medicare’s website states that “Not all providers can give acupuncture, and Medicare can’t directly pay Licensed Acupuncturists for their services.” Unfortunately, this rule limits access to most licensed practitioners of acupuncture in Georgia. On Medicare’s website, they continue to say that “Medicare also doesn’t cover acupuncture (including dry needling) for any condition other than chronic low back pain.”
Number of Sessions: Medicare Part B covers up to 12 acupuncture sessions within 90 days. If the patient shows improvement, Medicare may cover an additional eight sessions, totaling 20 sessions per year. Further sessions are not covered if there is no improvement after the initial treatments.
Documentation and Reporting: Practitioners must chart the patient’s progress and follow a treatment plan, including records of the initial diagnosis, treatment provided, and the patient’s response to each session.
How to Access Medicare-Covered Acupuncture
According to Medicare, “After you meet the Part B deductible, you pay 20% of the Medicare-approved amount.” For Georgia Medicare beneficiaries seeking acupuncture, the process typically involves the following steps:
Consultation: Schedule a consultation with a primary care physician in Georgia to discuss chronic low back pain and the potential benefits of acupuncture.
Referral and Verification: Ensure the acupuncturist meets Medicare’s qualification criteria, which involves verifying their credentials and confirming they are enrolled in Medicare.
Treatment Plan: Work with the acupuncturist to develop a treatment plan that adheres to Medicare’s guidelines, including the frequency and number of sessions.
Regular Evaluation: Continuously evaluate the treatment’s effectiveness. Medicare requires evidence of improvement to continue covering additional sessions beyond the initial 12 treatments.’
Conclusion
Medicare’s decision to cover acupuncture for chronic low back pain is a significant step in healthcare enhancement. However, the limitations, such as only covering low back pain and not directly paying licensed acupuncturists, indicate that more work is needed to improve this benefit for Medicare beneficiaries.
By understanding the history, rules, and guidelines of this coverage, patients can better navigate the process and make the most of this benefit. As healthcare evolves, we hope that more patients will receive acupuncture for diagnoses beyond low back pain and that licensed acupuncturists can directly receive reimbursement.
Metro Acupuncture has been helping patients of all ages with low back pain at our Sandy Springs clinic since 1998. While we are currently not Medicare providers, we hope that Medicare beneficiaries will be able to more quickly and conveniently have greater access to acupuncture and acupuncturists in the future. This therapy is both safe and effective. If you’re interested in booking an acupuncture appointment with us for your lower back pain or any other painful condition, you can book your appointment online here.
