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.
Can I claim acupuncture on Medicare?
You can get a maximum of 20 acupuncture treatments in a 12-month period. Medicare doesn't cover acupuncture (including dry needling) for any condition other than chronic low back pain. After you meet the Part B deductible, you pay 20% of the Medicare-approved amount.
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 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.
What diagnosis codes does Medicare cover for acupuncture?
Medicare covers acupuncture (CPT codes 97810-97814) for people with chronic low back pain (M54. 5, Low back pain), effective January 21, 2020. You will get a denial if your treatment exceeds the frquency limitations: Your patients can have up to 12 covered sessions in 90 days.
Does Medicare cover acupuncture for arthritis?
Acupuncture may be an effective treatment for some health conditions that affect seniors, such as rheumatoid arthritis or chronic lower back pain. Beginning January 21, 2020, Medicare Part B covers acupuncture treatment of chronic lower back pain for up to 12 sessions in 90 days and up to 20 sessions per year .
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 Medicare pay for acupuncture by a chiropractor?
Medicare doesn't cover other services or tests a chiropractor orders, including X-rays, massage therapy, and acupuncture (unless the acupuncture is for the treatment of chronic low back pain).
Do you have to pay for acupuncture?
Most acupuncture patients pay for private treatment. The cost of acupuncture varies widely between practitioners. If you're being treated by an acupuncture practitioner for a health condition or are considering having acupuncture, it's advisable to discuss this with your GP.
Does Medicare cover acupuncture for neck pain?
There's 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 doesn't pay for acupuncture to treat temporary acute pain, such as pain from a recent injury.
Does Medicare require a modifier for acupuncture?
11755 - 04.6 Contractors shall accept and process acupuncture for cLBP claims with the -KX modifier for the 13th through 20th service. NOTE: The 1st through 12th service over a 90-day period do not require the –KX modifier. There is a 20 service maximum per annum for this benefit.
What is the diagnosis code for low back pain?
Code M54. 5 is the diagnosis code used for Low Back Pain (LBP). This is sometimes referred to as lumbago.
How do you bill for acupuncture?
Bill a new patient for their first acupuncture visit using CPT codes 99201 to 99204. E/M services can be billed for periodic follow-up evaluations (every 30 days or every sixth visit using CPT codes 99211 – 99214) with established acupuncture patients.
How many acupuncture sessions does Medicare cover?
Medicare now covers 12 acupuncture sessions per 90 day period for the treatment of lower back pain and as many as 20 acupuncture sessions per year.
How long does acupuncture last?
Beginning January 21, 2020, Medicare Part B covers acupuncture treatment of chronic lower back pain for up to 12 sessions in 90 days and up to 20 sessions per year .
What is Medicare Part C?
Medicare Part C (Medicare Advantage) plans are private insurance plans that provide the benefits of original Medicare combined with options from private insurance companies.
Does Medicare cover physical therapy?
Physical therapy. Medicare Part B covers medically necessary physical therapy treatments. These treatments must be performed by a physical therapist who participates in Medicare and prescribed by a doctor who submits documentation showing that you need the treatment.
Which insurance plan covers alternative therapies?
Private insurance plans are the most likely to cover alternative therapies. While the initial cost of private insurance plans may be higher, these plans may reduce costs of alternative therapies. Tips for navigating Medicare choices. Medicare can be confusing and hard to navigate.
Can you buy a Medigap supplement plan with Medicare?
If you have a Medicare Advantage plan, ask your provider their policy for other alternative medical treatments. Medigap supplement plans can be purchased to increase the benefits of traditional Medicare coverage. These supplement plans cover things like deductibles and other out-of-pocket medical expenses.
Does Medicare cover chiropractic adjustments?
Medicare Part B covers adjustments to your spine performed by a chiropractor. If you have a diagnosis of a slipped bone in your spine, you may be eligible for medically necessary chiropractic treatments.
How long does it take for acupuncture to work?
If you have had low back pain for at least 12 weeks, and the pain is not associated with another cause (such as an infectious disease, surgery or pregnancy), you are entitled to 12 acupuncture sessions in a 90-day period. Medicare may pay for additional sessions if your pain decreases — up to eight more, to a maximum of 20 in a year.
Does Medicare cover acupuncture?
Until January 2020, Medicare did not cover it in any circumstances, and you will still pay 100 percent of the cost of acupuncture to address conditions other than low back pain.
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.
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.
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 Shoulder Pain?
Because the only approved coverage for acupuncture is as a treatment for chronic lower back pain, acupuncture for shoulder pain is not covered by Medicare.
Does Medicare Cover Acupuncture for Cancer Patients?
Medicare only covers acupuncture for chronic lower back pain that does not have a known medical cause, so lower back pain associated with cancer would not be covered. If you have cancer but your lower back pain is not related, and you also have chronic lower back pain, you may be able to get coverage.
Does Medicare Cover Acupuncture for Vertigo?
Many people believe that acupuncture can help with a variety of conditions, including vertigo. However, Medicare doesn’t provide coverage for acupuncture treatments for these ailments.
Does Medicare Cover Acupuncture for Arthritis?
While many people claim that acupuncture can help reduce the pain associated with arthritis, Medicare does not cover acupuncture treatment for that purpose at this time. However, there are other arthritis treatments that might be covered.
