Does Medicare Cover Acupuncture
People who are battling certain health issues may find pain relief through medication. Several medications or therapies are present for such purposes.
One such therapy they may consider is acupuncture. However, it’s still considered to be an alternative treatment. Many people may want to get it covered under their insurance.
However, does Medicare cover acupuncture?
It’s quite a common question. For a quick answer, Medicare does cover acupuncture. Medicare covers up to 12 acupuncture visits in 90 days for chronic low back pain.
If improvement is noted, 8 additional sessions may be covered, for a total of 20 sessions per year.
Here, we can discuss treatment for lower back pain in terms of the Medicare acupuncture therapy sessions. Medicare doesn’t cover acupuncture therapies apart from lower back pain.
Further, in this article, we’ll discuss the basics of acupuncture, its benefits, Medicare’s acupuncture coverage, and more.
What is Acupuncture
Acupuncture is a traditional Chinese medicine practice. In traditional Chinese medicine, imbalances in the body’s qi are believed to cause illness. Restoring qi flow is thought to improve health.
Acupuncture is believed to stimulate the central nervous system.
This stimulation may release chemicals into the muscles, spinal cord, and brain, which might promote the body’s natural healing processes.
This may offer assistance to make strides in physical and enthusiastic wellness.
Benefits of Acupuncture
Recent studies have shown that Acupuncture may offer assistance to treat a few torment conditions, particularly in the back, knee, and neck torment, as well as migraines and headaches.
In any case, the American Foundation of Therapeutic Acupuncture states that acupuncture can also:
- Reduce pain or/and other side effects from cancer treatments
- Helps quit smoking
- Act as a complementary treatment for diabetes
- Treat allergies
- Lessen depression, anxiety, and insomnia symptoms
Does Medicare Cover Acupuncture
CMS, or Centers for Medicare & Medicaid Services, announced on January 21, 2020, that Acupuncture would be covered under the federal Medicare program, specifically for low back pain.
The federal government’s attempts to combat opioid abuse in the United States were the basis for this decision. The idea behind covering acupuncture was to provide an alternative to prescription opioids for treating chronic low back pain.
Acupuncture treatments must meet specific criteria to be covered in this scenario. Furthermore, the policy only covers chronic lower back discomfort.
Medicare Advantage And Acupuncture Coverage
A Medicare Advantage Plan, often known as Medicare Part C, is a commercial insurer’s version of Medicare. It includes coverage for both Medicare Parts A and B.
It also includes Medicare Part D, which provides coverage for prescribed drugs.
Medicare Advantage (Part C) plans must cover at least the same acupuncture benefits as Original Medicare, but many plans offer additional coverage for other conditions beyond chronic low back pain, which means that persons with this medicare plan must meet the exact acupuncture coverage requirements.
Some Medicare Advantage plans might offer acupuncture benefits for conditions other than chronic low back pain.
Beneficiaries of Medicare should contact their insurance provider to learn more about their unique program and situation coverage.
Medicare Advantage plans may offer additional acupuncture benefits beyond those covered under Original Medicare.
However, it’s essential to realize that the most advantageous plans include additional benefits.
Examine your coverage to determine how your medicare advantage plan, commonly known as Medicare Part C, covers Acupuncture. Acupuncturists may also be part of your provider network. Providers must document improvement in pain and function to justify additional sessions beyond the initial 12 visits.
Always check that the provider you choose accepts your insurance plan to guarantee that your Medicare plan covers any service you receive.
Comparing medicare plan options is simple with our find a planning tool. Enter your zip code and expected coverage start date to compare medicare plans.
How To Qualify for Acupuncture Coverage In Medicare?
You only qualify for acupuncture treatments under Medicare if you have chronic low back pain.
- Lower back pain must meet the following criteria to be covered by Medicare
- The pain must not be associated with surgery, pregnancy, or any underlying condition like infectious disease.
- Last for a minimum of 12 weeks
- Infectious, inflammatory, or metastatic disease cannot be the cause.
Medicare will fund acupuncture treatments if you meet these requirements (and have Medicare Part B). For covered acupuncture treatments in 2025, after meeting the $240 Part B deductible, beneficiaries pay 20% of the Medicare-approved amount
Information About Acupuncture and Medicare
Acupuncture providers must also meet specific standards set forth by Medicare.
A healthcare provider must administer acupuncture treatments, such as a doctor, physician assistant, or nurse practitioner.
- Providers must have a master’s or doctoral degree in acupuncture or Oriental medicine from an institution accredited by the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM).
- The provider’s degree must be from an Accreditation Commission on Acupuncture and Oriental Medicine-accredited school.
- Their license must be valid, active, and unrestricted in the state where the service is offered.
If you are confused when looking for a registered acupuncturist, the National Certification Commission for Acupuncture and Oriental Medicine is an excellent place to start (NCCAOM).
How does Acupuncture work
Qi (stated Chee) is a sort of electricity that travels via these meridians and acupuncture factors. In Oriental medicine, the disease results from a power imbalance that disrupts the normal flow of strength.
Acupuncturists place tiny needles at specific acupuncture locations to redirect electricity drift and bring the body into equilibrium.
Though this could sound more legendary than medicinal, Western medicine explains the effectiveness of acupuncture as follows: The mind circuits, muscle tissues, and connective tissues are all represented with the aid of acupuncture factors.
Increased blood flow helps trigger your body’s natural healing response when certain areas are stimulated.
Is Acupuncture Effective?
Although acupuncture has been practiced for many years, it did not grow to be popular in the US until the Nineteen Seventies.
Alternative medication, including acupuncture, has recently started to be recognized through Western medicinal drugs within the past twenty years.
Acupuncture is also being considered majorly through private insurance companies nowadays.
Millions of patients benefit from acupuncture to deal with several illnesses, including continual low again ache, covered by Medicare.
- Addiction
- Arthritis
- Chronic pain
- Headaches and migraines
- Insomnia
- Stress and anxiety
Acupuncture is also utilized by many people living with cancer to manipulate their signs and symptoms, particularly treatment options like chemotherapy and radiation.
Medicare doesn’t always protect acupuncture for illnesses other than chronic back aches.
However, Medicare no longer covered that for fifty-five years. However, it now does. Who knows how the benefits of acupuncture in Medicare will evolve in the future?
Why Does Medicare Cover Acupuncture?
Medicare selected two predominant motives to cover acupuncture to deal with chronic pain. According to the CDC, in 2022, the national dispensing rate was 43.3 prescriptions per 100 persons, down from the peak of 81.3 in 2012.
- Hydrocodone
- Methadone
- Oxycodone
These prescribed drugs are addictive, and it could be almost impossible to triumph over the addiction. The pleasant thing patients can wish for is a remedy that helps satisfy their body’s craving for opioids.
The severe risks inherent in taking opioids have led many healthcare vendors to discover alternative methods for managing continual aches—several studies guide acupuncture’s effectiveness in treating chronic pain.
Medicare may cover acupuncture alongside other treatments for chronic low back pain, such as physical therapy or chiropractic care, when medically necessary.
How to Qualify For Medicare?
The following must be real so as for Medicare to define a situation as persistent lower returned pain:
- Signs must be a gift for 12 weeks or more
- No identifiable systemic reason (i.e., cannot be associated with metastatic cancers, inflammatory, or infectious ailment)
- Ache is no longer related to surgical procedures or pregnancy
- Acupuncture should be administered with the aid of a doctor, doctor assistant, nurse practitioner, or through every other fitness care issuer who has the subsequent qualifications:
Necessary Qualifications of Acupuncture Practitioners
A grasp’s or doctoral acupuncture degree from a college approved by the Accreditation Commission on Acupuncture and Oriental Medicinal Drugs; an Oriental medicinal drug degree at the master’s or doctorate level is also familiar.
Acupuncture Services Covered by Medicare
Original Medicare covers acupuncture only for chronic low back pain.
Medicare covers acupuncture specifically for chronic low back pain that meets certain criteria.
This is described as an ache without a systemic reason and should no longer be connected to the surgical operation or pregnancy.
The discomfort ought to have lasted for 12 weeks or longer.
Acupuncture must be performed by a healthcare provider with a master’s or doctoral level degree in acupuncture or Oriental medicine and licensure that allows them to practice acupuncture in their state.
The issuer must also have a license to perform acupuncture in your country.
If those conditions are met, Medicare will cover 12 acupuncture appointments within 90 days.
Those other appointments aren’t paid for using Medicare if your health practitioner does not think the remedy will improve your pain.
Medicare Part B covers up to 20 acupuncture visits per year for chronic low back pain if the patient shows improvement.
Acupuncture coverage in Medicare Advantage Plans (Part C)
Medicare plans provide extra insurance for services not covered through unique Medicare. What’s precisely protected depends on the Medicare plan you pick out.
These are offered to utilize private insurers whose terms range.
For instance, maximum Medicare Plan C provides dental and vision care. Some provide additional perks like health club memberships.
Some programs can also consequently encompass extended acupuncture insurance. So once you get acupuncture, review your component C plan’s hints about whose offerings are protected.
Summary
During the COVID-19 Public Health Emergency, some acupuncture services were available via telehealth. As of 2024, acupuncture must be provided in person to be covered by Medicare.
Patients with chronic health troubles may search for alternative treatments to discover remedies for their ailments. One such remedy is acupuncture.
The query, then, is whether Medicare covers it. Medicare covers acupuncture under favorable situations.
One insurer may additionally pay for services as much as asset limits.
This could appear for a few specific reasons. Perhaps your health practitioner recommends acupuncture for persistent lower back pain, which includes a medicare supplement to cover those costs.
Your coverage alternatives are in addition to any special discounts provided through male or female practitioners.
Of course, you must choose any healthcare company based on their expertise and feel secure.
Once you have a licensed acupuncturist in mind, you can ask if they offer discounts for medicare patients or seniors.
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