Medicare To Cover Limited Acupuncture Service

For the first time, Medicare will cover limited medically reasonable and necessary acupuncture services for chronic lower back pain. Prior to this change, no forms of acupuncture were covered by the Medicare program. Medicare’s new acupuncture limited coverage is as follows:

• Up to 12 acupuncture services/visits in 90 days for chronic lower back pain^*
• An additional eight visits may be approved if the treatment results in improvement
• Up to 20 acupuncture services can be provided yearly
• Failure to show improvement for your chronic lower back pain, or if the pain worsens, then no additional services will be covered

^* Medicare defines “chronic lower back pain” as a condition that:

• Lasts 12 weeks or longer
• Has pain that is not associated with surgery or pregnancy
• Has no identifiable systemic cause – such as metastatic, inflammatory or infectious diseases, etc.

According to the Mayo Clinic, acupuncture, also known as “dry needling,” involves the “insertion of very thin needles through your skin at strategic points on your body. A key component of traditional Chinese medicine, acupuncture is most commonly used to treat pain.” For Medicare, you can receive acupuncture from physician assistants, nurse practitioners/clinical nurse specialists, as well as auxiliary personnel who meet all applicable state requirements and have:

• A masters or doctoral level degree in acupuncture or Oriental Medicine from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine (ACAOM); and
• A current, full, active, and unrestricted license to practice acupuncture in a State, Territory, or Commonwealth (i.e. Puerto Rico) of the United States, or District of Columbia, where the service is being performed.

The Mayo Clinic offers guidance on finding an acupuncture professional. To learn more, please visit their website.

Medicare’s coverage of acupuncture is limited to the treatment of chronic lower back pain.  Medicare does not cover any type of acupuncture, including “dry needling”, for any other condition including fibromyalgia and osteoarthritis.

If you have questions about how Medicare covers this new service, you may call our Beneficiary Contact Center at 800-833-4455, or for the hearing impaired, call TTY/TDD at 877-566-3572. Customer Service Representatives are available Monday through Friday, from 8:30 a.m. until 7 p.m. ET.