Does Medicare Cover Acupuncture?
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Medicare Part B (medical insurance) doesn't cover acupuncture, except in one very limited circumstance, and for limited visits each year. The number of treatments you receive also depends on whether your doctor determines you’re improving.
Medicare started covering acupuncture specifically for lower back pain in 2020, in an effort to increase access to alternatives to prescription opioids for pain relief.
What is acupuncture?
Acupuncture is a traditional Chinese medical practice in which very thin needles are inserted through the skin at specific points on the body. It may be used to treat pain or for overall wellness, including stress management. By inserting needles at strategic points, practitioners believe they can help balance the flow of energy through the body.
When does Medicare cover acupuncture?
Medicare Part B will cover acupuncture only for chronic low back pain, which is defined by Medicare as:
Lasting 12 weeks or more.
Having no known cause (for instance, it’s not related to an inflammatory disease).
Pain not associated with surgery or pregnancy.
You must receive acupuncture from a doctor or health care provider who has both of these qualifications:
A master's or doctoral level 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 the state where you’re receiving the care.
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What are the limits on Medicare acupuncture coverage?
Medicare will cover up to 12 visits in 90 days, plus an additional eight visits if you’re improving. If your doctor thinks your back pain isn’t getting better or is getting worse, Medicare won’t cover those additional eight visits. Medicare will cover no more than 20 acupuncture treatments in a year.
Your Medicare Part B covers the majority of the cost for the lower back pain treatments. If you have a Medigap plan, it would pick up your share of the cost. Otherwise, you would be responsible for the remaining 20%.
Does Medicare Advantage cover acupuncture?
Medicare Advantage plans — or Medicare Part C plans — are required to offer the same coverage that Medicare Part A and Part B provide, and they may also offer additional benefits. So your Medicare Advantage plan will cover this specific treatment for lower back pain.
A few Medicare Advantage plans have started adding coverage for additional acupuncture treatments beyond 20 per year. Check with your plan provider to see if it covers acupuncture under additional circumstances, or covers more treatments.
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