According to the CMS
Centers for Medicare and Medicaid Services
The Centers for Medicare & Medicaid Services, previously known as the Health Care Financing Administration, is a federal agency within the United States Department of Health and Human Services that administers the Medicare program and works in partnership with state government…
Acupuncture
Acupuncture is a form of alternative medicine and a key component of traditional Chinese medicine in which thin needles are inserted into the body. Acupuncture is a pseudoscience because the theories and practices of TCM are not based on scientific knowledge, and it has been characteriz…
Full Answer
Which Medicare Advantage plans cover acupuncture?
Outside of Medicare Part B, many private insurance plans are also beginning to offer acupuncture coverage through their policies. For example, Aetna, Blue Cross and Blue Shield and UnitedHealthcare provide varying levels of coverage via some of their Medicare Advantage plans.
Does Medicare cover acupuncture treatments?
On January 21, 2020, CMS announced that Medicare would cover acupuncture treatments for chronic lower back pain. Medicare previously did not pay for any ailment treated with acupuncture. Medicare Part B covers out-of-hospital medical treatment.
When does Medicare cover acupuncture?
Acupuncture is covered under Medicare Part B, the medical insurance portion of Original Medicare. Medicare Part B only covers acupuncture in cases of chronic lower back pain. If this is the case, Medicare Part B covers up to 12 sessions of acupuncture in a 90-day period.
Is acupuncture covered under my insurance?
The good news is that yes, many insurance companies now offer policies that cover acupuncture and related services performed by an acupuncturist. Does my insurance cover acupuncture? You can find out if your insurance provides acupuncture benefits by calling your insurance company's patient information or benefits line.
How many sessions of acupuncture does Medicare cover?
12 acupuncture visitscovers up to 12 acupuncture visits in 90 days for chronic low back pain. Medicare covers an additional 8 sessions if you show improvement. If your doctor decides your chronic low back pain isn't improving or is getting worse, Medicare won't cover your additional treatments.
Why does Medicare not pay for acupuncture?
Why Doesn't Medicare Cover Acupuncture? Mostly, Medicare doesn't cover acupuncture (outside of relief for chronic lower back pain) because this treatment is still considered naturopathic care. For those with chronic pain in other places, you'll likely need to see a pain management specialist.
Can an acupuncturist enroll in Medicare?
“Currently, acupuncturists are not recognized by CMS as Medicare providers, and are not eligible to bill for acupuncture services. It is possible, however, for acupuncturists to provide acupuncture as auxiliary personnel 'incident to' a physician's service in certain settings.
Does Medicare supplement pay for acupuncture?
Since Medicare Supplement plans work alongside Original Medicare coverage, they typically wouldn't cover acupuncture. Even though Medicare Supplement Plan F* provides the most comprehensive basic benefits for Original Medicare's out-of-pocket costs, it would generally not cover acupuncture.
Does Medicare pay for acupuncture for neuropathy?
Yes, both acupuncture and chiropractic care are covered under Medicare Part B. Be sure to check with your insurance and medical providers for coverage information before making an appointment.
Does Medicare cover acupuncture for peripheral neuropathy?
Unfortunately, Original Medicare generally does not cover acupuncture. If you rely upon Medicare Part A and B for your Medicare coverage, you will generally have to pay the entire cost for this kind of alternative medicine.
When did Medicare start covering acupuncture?
2020Is acupuncture covered by Medicare? Acupuncture is the practice of applying tiny needles to specific areas in the body to relieve pain and restore energy flow. In 2020, Medicare began covering acupuncture as a treatment for lower back pain.
Does Blue Shield Medicare Supplement cover acupuncture?
Benefits offer access to more than 2,400 acupuncturists1 in the American Specialty Health Network who offer acupuncture for conditions related to pain. Covered services include: Initial and subsequent examinations. Acupuncture.
Is chiropractic covered by Medicare?
As part of your Medicare coverage you are entitled to up to five bulk billed chiropractic visits a year fully paid for by Medicare. This is organised by your GP through a Chronic Disease Management plan (CDM) or Team Care Arrangement (TCA). This coverage can save you over $250 in health care costs.
How many acupuncture sessions are needed for back pain?
Nice guidelines from 2009 on the early management of low back pain recommended that healthcare providers “consider offering a course of acupuncture needling comprising up to a maximum of 10 sessions over a period of up to 12 weeks.”
Can acupuncture harm you?
The risks of acupuncture are low if you have a competent, certified acupuncture practitioner using sterile needles. Common side effects include soreness and minor bleeding or bruising where the needles were inserted. Single-use, disposable needles are now the practice standard, so the risk of infection is minimal.
Does acupuncture do anything?
Acupuncture points are believed to stimulate the central nervous system. This, in turn, releases chemicals into the muscles, spinal cord, and brain. These biochemical changes may stimulate the body's natural healing abilities and promote physical and emotional well-being.
Acupuncture Coverage Under Medicare
During an acupuncture procedure, a practitioner penetrates a patient’s skin with fine needles that are placed at strategic areas. This practice is believed to balance blood flow and stimulate nerves and connective tissue.
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:
Benefits of Acupuncture Treatment
Acupuncture’s roots can be traced back to traditional Chinese medicine, which is a system of health care delivery techniques that include tai chi and the utilization of herbal medicines to address ailments.
What is the Medicare Approved Rate for Acupuncture?
The specific amount Medicare will pay your provider for acupuncture treatment depends on a variety of factors, including the length of each appointment and the specific medical billing codes used.
Does Medicare Cover Acupuncture for Lower Back Pain?
Acupuncture is only covered by Original Medicare Part B if it is for the treatment of chronic low back pain, and the acupuncture treatment must be administered as part of a doctor’s care plan for your pain.
Why do people in China use acupuncture?
People in China are using acupuncture for centuries to treat pain and promote overall well-being. A skilled professional applies tiny needles to stimulate energy flow and alleviate pain in specified body areas.
How many sessions can you have with Medicare?
Participants can have up to 12 sessions over 90 days, with eight additional sessions possible if their symptoms improve. Medicare Part D coverage is expected to last no more than 20 visits spread out over 12 months.
What degree do you need to be an acupuncturist?
To be covered by the program, the acupuncturist must be a doctor. Licensed medical practitioners with a master’s or doctoral degree and training in acupuncture may perform this treatment.
What is physical therapy?
Physical therapy is often used to work on the back muscles, relieve tension, and help strengthen and stretch the patient. For Part B, deductible and coinsurance requirements apply.
Does acupuncture help with hyperactive pain?
This process could cause the release of natural pain-relieving chemicals. Acupuncture can help “quiet down” hyperactive pain sensors.
Does Medicare cover acupuncture?
On January 21, 2020, CMS announced that Medicare would cover acupuncture treatments for chronic lower back pain. Medicare previously did not pay for any ailment treated with acupuncture. Medicare Part B covers out-of-hospital medical treatment.
Does Medicare cover chiropractic care?
In treating subluxation, Medicare covers chiropractic services. When the spine bones don’t line up, this adds stress and pressure on the nerves in the back, which causes pain.
How long does it take for acupuncture to be covered by Medicare?
Your pain isn't related to surgery or pregnancy. Medicare will cover up to 12 acupuncture visits in 90 days.
How many acupuncture visits can Medicare cover?
Medicare will cover up to 12 acupuncture visits in 90 days. If you show improvement, it will cover up to eight additional sessions, but you can’t get more than 20 covered sessions in a year.
What if I Have a Medicare Advantage Plan?
Many people opt for a Medicare Advantage plan over Original Medicare. The Kaiser Family Foundation reported that 33 percent of Medicare beneficiaries are enrolled in Medicare Advantage plans.
How popular is acupuncture?
Acupuncture is wildly popular. According to a July 2014 article in Global Advances in Health and Medicine, more than 10 million acupuncture treatments are administered in the United States every year. Used primarily for pain relief, acupuncture is considered an alternative treatment for headaches, joint pain, and even to reduce cancer pain.
How much does acupuncture cost?
According to a study published in the Journal of Integrative Medicine in September 2019, the median cost for a first-time acupuncture visit was $112, ...
What is the most common type of acupuncture?
While multiple types of acupuncture exist, the most common involves needles. Medical professionals insert tiny needles through the skin to stimulate specific points on the body. When you go in for an acupuncture session, the acupuncturist will ask you to lie on a padded table.
Does Medicare pay for acupuncture?
According to UnitedHealthcare, some Medicare Advantage plans will pay for acupuncture for a range of conditions, including pain relief beyond chronic low back pain, neuromusculoskeletal disorders, and nausea.
When will acupuncture be covered by CMS?
05/2020 - The purpose of this change request is to inform MACs that CMS will cover acupuncture for chronic low back pain (cLBP) effective for claims with dates of service on and after January 21, 2020. ( TN 10128 ) (CR11755)
What is the selection and manipulation of specific acupuncture points by a variety of needling and non-need?
Acupuncture is the selection and manipulation of specific acupuncture points by a variety of needling and non-needling techniques.
Is acupuncture covered by Social Security?
Effective for claims with dates of service on and after January 21, 2020, acupuncture is only covered for chronic low back pain under section 1862 (a) (1) (A) of the Social Security Act (the Act). See National Coverage Determination section 30.3.3 for specific coverage criteria.
Does Medicare cover acupuncture?
Medicare reimbursement for acupuncture, as an anesthetic, or as an analgesic or for other therapeutic purposes, may not be made unless the specific indication is excepted. All indications for acupuncture outside of NCD section 30.3.3 remain non-covered.
How many acupuncture visits are covered by Medicare?
For Medicare-covered acupuncture, guidelines stipulate that up to 12 visits in the first 90 days may be covered for Medicare beneficiaries. Up to eight additional sessions may be covered for patients who demonstrate improvement, but no more than 20 acupuncture treatments may be administered annually.
How long does acupuncture last?
It has lasted 12 weeks or longer . There is no known cause (not related to cancer that has spread, inflammatory, or infectious disease). Pain not associated with surgery or pregnancy. As of current Medicare acupuncture coverage regulations, no other sources of back pain will be covered. However, it’s not that simple.
What is holistic billing?
At Holistic Billing Services, we deal exclusively with holistic healthcare practices like acupuncture, massage therapy, and chiropractic treatment. Our team of experienced billing and coding experts understand the unique needs of holistic practices – such as acupuncturist practices – and can help you take steps to accelerate your revenue cycle management. For any questions about holistic billing, feel free to contact our team today and let us know how we can help your acupuncture practice.
What is the American Society of Acupuncturists' goal?
In early 2021, their goal is to secure bipartisan support for the bill and organize acupuncturist advocacy campaigns to increase awareness of their bill.
Can acupuncturists bill Medicare?
Furthermore, since licensed acupuncturists are not currently included on the list of Medicare provider groups, there is currently no way for them to directly bill Medicare for reimbursement. Hypothetically, if they were added to the list of qualified provider groups, they would be able to bill for eligible services (currently chronic lower back pain).
Can auxiliary personnel bill Medicare?
Following this logic, then, auxiliary personnel cannot directly bill Medicare for any services rendered because they are not the registered Medicare provider. The supervising physician may bill Medicare for acupuncture treatments for lower back pain (with some restrictions), but the acupuncturist cannot do so themselves.
Is acupuncture on Medicare?
Despite several attempts to add acupuncturists to the list of Medicare providers over the past 40 years (most recently with the Acupuncture for Heroes and Seniors Act, introduced in 2015 and reintroduced in 2017 and 2019), none of them have received a committee hearing in Congress.
