Medicare Part B covers 12 acupuncture sessions with a qualified, licensed medical professional within 90 days to treat medically diagnosed chronic lower back pain.

Acupuncture is a holistic remedy that has been practiced for thousands of years. Research suggests that, depending on the circumstances, acupuncture may be an effective treatment for acute and chronic pain.

In part as a response to the opioid crisis, on January 21, 2020, the Centers for Medicare & Medicaid Services (CMS) issued new rules regarding Medicare coverage for acupuncture treatment. Since then, Medicare has covered 12 acupuncture sessions within a 90-day period for the treatment of lower back pain and up to 20 acupuncture sessions per year.

Medicare Part B covers acupuncture treatments for the treatment of lower back pain. These treatments must be conducted by a medical doctor or other qualified healthcare professional such as a nurse practitioner or physician assistant who has both these qualifications:

  • a master’s or doctoral level degree in acupuncture or Oriental Medicine from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine (ACAOM)
  • a current, full, active, and unrestricted license to practice acupuncture in the state where care is being provided

Medicare Part B covers 12 acupuncture sessions within 90 days and up to 20 sessions per year. If you show improvement during treatment, the additional 8 sessions may be covered.

You qualify for coverage for acupuncture treatment coverage if:

  • You have a diagnosis of lower back pain that has lasted 12 weeks or longer.
  • Your back pain has no identified systemic cause or is not associated with metastatic, inflammatory, or infectious disease.
  • Your back pain is not associated with surgery or pregnancy.

Medicare only covers acupuncture treatment for medically diagnosed chronic low back pain.

Acupuncture costs can vary according to your provider and where you live. Your first appointment may be the most expensive, as you will need to pay for the consultation fee as well as any treatment.

If you have Medicare Part B, you will be responsible for 20% of that fee and your Part B deductible.

Because rates can vary, ask your practitioner how much your session will cost. Get an estimate in writing, if you can, before you agree to be treated by your chosen acupuncture provider. To be covered by Medicare, any acupuncture practitioner must meet Medicare requirements and agree to accept Medicare payment.

While Medicare doesn’t cover most alternative therapies, you may be covered for some alternative treatments under specific circumstances.

Massage therapy

At this time, Medicare doesn’t cover massage therapy, even in instances when it’s prescribed by your doctor.

Chiropractic treatment

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.

According to Medicare’s policies, you’ll still be responsible for 20% of the treatment’s cost, as well as your Medicare Part B yearly deductible.

Medicare does not cover other services a chiropractor might provide or prescribe, such as massage therapy and tests ordered by a chiropractor, such as X-rays.

Medicare does not cover acupuncture if prescribed by a chiropractor. To be covered, it must be prescribed by a medical doctor.

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.

You’ll still be responsible for 20% of the treatment cost, as well as your Medicare Part B yearly deductible.

In addition to Medicare Part A and Medicare Part B, there are additional plans that you can purchase to increase your coverage.

Medicare Part C (Medicare Advantage) plans are private insurance plans that provide the benefits of Original Medicare combined with options from private insurance companies. Advantage plans must cover services that Medicare Part B covers, so any Medicare Advantage plan must cover acupuncture at least the same as Medicare Part B.

Part C may deny claims for alternative treatments. If you have a Medicare Advantage plan, ask your provider about 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.

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 the costs of alternative therapies.

Tips for navigating Medicare choices

Medicare can be confusing and hard to navigate. Whether you’re enrolling yourself or helping a loved one, here are some suggestions help during the process:

  • Make a list of your medical conditions and all medications you take. Knowing your current medical needs will help when you search Medicare.gov or talk to the Social Security Administration.
  • Search Medicare.gov for specific details on all Medicare plans. Medicare.gov has tools to help you search for coverage based on many factors, such as your age, location, income, and medical history.
  • Contact the Social Security Administration for any questions. Medicare enrollment is managed by the Social Security Administration. Contact them before you enroll. You can call, look online, or schedule an in-person meeting.
  • Take notes during any calls or meetings preparing for enrollment. These notes can help clarify information about healthcare and coverage.
  • Make a budget. It’s important to know exactly how much you can afford to pay for your Medicare benefits.

Acupuncture may be an effective treatment for some health conditions that affect seniors, such as rheumatoid arthritis or chronic lower back pain.

Since January 21, 2020, Medicare Part B has covered acupuncture treatment of chronic lower back pain for up to 12 sessions in 90 days and up to 20 sessions per year.