Acupuncture has been shown to have benefits for those suffering from chronic pain, but is still a non-traditional treatment option. If you’re interested in receiving acupuncture treatments and rely on Medicare for your health care, you might have questions about whether Medicare provides coverage.
Keep in mind that the answer may be different depending on whether you have Original Medicare (Parts A and B) or a Medicare Advantage plan. Medicare Advantage (sometimes referred to as “Medicare Part C”) will offer at least as much coverage as Original Medicare but may have additional benefits, as well.
Let’s take a look at Medicare coverage for acupuncture.
Medicare does offer some coverage for acupuncture, but only in very limited circumstances. If you’re interested in getting broad coverage for acupuncture treatment from Medicare and this is important to you, you might take a look at your options with Medicare Advantage.
This coverage was introduced in 2020 as a way to find alternatives to pain medication prescriptions that can be addictive or have serious side effects.
As we mentioned, the coverage and costs may be significantly different if you have a Medicare Advantage plan. You should contact your plan provider directly to get the details around what is covered.
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 does chronic lower back pain mean? It refers to pain that:
You can receive up to 12 acupuncture visits within 90 days, and up to eight more if you show improvement in your condition and pain has been reduced as a result. You cannot receive more than 20 treatments in a year. You also need to get acupuncture from a doctor or a medical professional with specific Master’s or Doctorate level credentials.
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.
If you have Original Medicare and your acupuncture or dry needling treatment is covered, you will pay 20% of the Medicare-approved cost after your deductible and Medicare will cover the rest.
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.
Because acupuncture is considered a naturopathic treatment, it’s seen as a non-proven method of treatment. There’s not enough evidence that people see consistent improvement from these treatments, so insurance — including Medicare — is unlikely to cover them.
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.
Medicare will help you cover the costs of treating your cancer overall, but will provide payment for proven medical interventions rather than naturopathic treatments.
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.
If you have vertigo, you might see your doctor about getting other medical treatments that would be covered by Medicare. In many instances, you can do exercises at home that help vertigo go away without further medical care or need for treatment. However, you may also need medication or even surgery, depending on the cause.
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.
For example, medication can be helpful in reducing your pain. Physical therapy may also be helpful. In some extreme cases, your doctor might recommend joint surgery such as repair or replacement.
Medicare’s coverage of acupuncture for chronic lower back pain is a very recent development, and it’s one that shines a light on the effectiveness of naturopathic treatment in some cases.
If you have more questions about Medicare and acupuncture, or you’d like to compare Medicare plans to choose the right ones for your needs, talking to a licensed agent can help. Contact us today for more information!