Does Medicare Cover Acupuncture Treatments?

Acupuncture is defined as a holistic remedy that has a history that stretches back thousands of years. Medical tests indicate that this could be an effective treatment for chronic pain, depending on your circumstances. 

In direct response to the opioid crisis, the Centers for Medicare & Medicaid Services issued new rules and regulations regarding Medicare benefits and the coverage for acupuncture. But, what are these new regulations and does Medicare pay for any acupuncture services?

Medicare Benefits Solutions

Jan 26, 2022

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When Medicare Will Cover Acupuncture Treatment

If you’re wondering how much Medicare pays for acupuncture, Medicare Part B will cover the cost of acupuncture treatment for lower back pain. The treatment has to be done by a qualified healthcare professional or doctor. You can have a physician assistant or a nurse practitioner do it as well if they have the following: 

  • Masters or doctoral-level degree in Oriental Medicine or acupuncture from a school with an accreditation from the Accreditation Commission on Acupuncture and Oriental Medicine
  • Active, current, full, and unrestricted license to practice acupuncture in your state

Medicare Benefits under Part B will currently pay for 12 acupuncture sessions over the span of 90 days and up to 20 sessions per calendar year. If you start showing improvement during your treatment, Part B can pay for an additional eight sessions. You can qualify for this coverage if you: 

  • Have a diagnosis of lower back pain that spans back 12 years or more
  • Your back pain isn’t associated with pregnancy or surgery
  • Your back pain doesn’t have an identified systemic cause, and it’s not associated with inflammatory, metastatic, or infectious diseases

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Getting Coverage for Alternative Medicine Under Medicare

In addition to Original Medicare benefits with Part A and Part B, you can consider other plans to increase your insurance coverage. Medicare Advantage plans are offered by private insurance companies that give you the same benefits that you’d get under Original Medicare, but many offer additional benefits such as acupuncture treatment or chiropractic care

These MA plans are required to cover the services that Part B does, so most Medicare Advantage plans will have coverage for acupuncture treatments at the same rate as you’d get under Original Medicare. If you currently have one of the Medicare Advantage plans, check with your plan directly to find out about coverage for acupuncture and other alternative medical treatments. 

Medigap Supplement plans are something you can buy to increase the benefits you get under Original Medicare. The Medicare Supplement plan may help cover your out-of-pocket expenses. Generally speaking, private insurance companies are more likely to have coverage for alternative therapies like acupuncture. The initial costs for these plans might be higher upfront, but they can save you in the long run.

Average Cost for Acupuncture Services

The cost of acupuncture treatments will vary according to your location and the provider. The first appointment can be the most expensive one because you may have to pay an initial consultation fee along with the treatment cost. 

Medicare also hasn’t given an exact number for the amount they’ll pay for acupuncture treatment. Once they do set an amount, you’ll be responsible for paying 20% of the fee with your Part B deductible. If you don’t have Medicare, you could pay $100 or more for your initial treatment, and any subsequent visits will cost between $50.00 and $75.00. 

Since your rates can vary, ask your doctor how much each session will cost before you sign up for them. You want to get an estimate in writing before you agree to have treatment with your chosen acupuncture provider. Any practitioner you choose must meet specific Medicare requirements and agree to accept payments from Medicare.

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