In past, Medicare did not cover acupuncture to treat any condition. On January 21, 2020, the Centers for Medicare & Medicaid Services (CMS) declared that they would cover acupuncture services to help treat chronic lower back pain. Medicare Part B is the part that would cover these treatments, as this accounts for nonhospital medical treatments.
The new command provides Medicare coverage for up to 12 sessions in 90 days. In case a person experiences an improvement in their symptoms there is a chance of an additional eight sessions. Medicare only covers up to 20 sessions across 12 months, based on available research about the lasting effects of acupuncture treatments.
For the program to cover acupuncture, the practitioner must be a doctor. If not, a physician’s assistant, nurse practitioner, or healthcare professional can administer this treatment, since they have master’s or doctorate level training in acupuncture and a state license to practice acupuncture.
Medicare has executed revised acupuncture coverage as part of a developing effort to help people access nonopioid pain management. In a press release declaring the decision to expand coverage for acupuncture, the CMS reviewed several studies that supported using acupuncture in treating lower back pain.
Do Medicare Advantage plans cover acupuncture?
Medicare Advantage is an alternative to traditional Medicare. A person having this plan pays a private insurance company for parts A, B, and D. This coverage includes hospital care, medical care, and prescription drugs. Some people select these policies because they also cover additional services, like dental or eye care. Medicare Advantage plans provide the same level of coverage as traditional Medicare, including the same medical procedures and treatments. Hence, the program will also cover acupuncture for lower back pain.
Some Medicare Advantage plans may broaden acupuncture coverage to treat other conditions. A deductible and copayment may still apply. Many of these plans require a person to choose healthcare providers from a limited network, a requirement that may extend to acupuncture professionals. Other plans need a physician to refer individuals to an acupuncture professional before Medicare covers the costs.
How does acupuncture work for back pain?
Acupuncture is a traditional Chinese medicine practice used for thousands of years to relieve pain and promote wellness. In this technique, a trained professional applies tiny needles to specific areas of the body to activate energy flow and relieve pain. This process triggers the release of naturally occurring pain-relieving chemicals in the body. Imaging studies of brains have also shown that when people receive acupuncture, the method helps “quiet down” overactive pain sensors.
The effects of acupuncture on chronic pain can be long-lasting. In an analysis of clinical trials involving people with headaches or pain in the lower back, neck, shoulder, or knee, an estimated 90%Trusted Source of participants reported pain relief lasting at least 12 months after their acupuncture treatments.
Additionally, the technique does not usually cause notable side effects, with the most common being pain and bleeding at the needle insertion site.
What other conditions can acupuncture heal?
Acupuncture can treat a variety of medical conditions. As per estimation around 37,000 licensed acupuncturists currently practice in the United States.
According to the American Academy of Medical Acupuncture, acupuncture can help relieve symptoms of the following conditions:
- constipation and diarrhea
- gynecological disorders
Although practitioners may use the technique to treat other conditions, Medicare will only cover its use to treat lower back pain.
Medicare does not cover some services to treat back pain, such as massage therapy. However, it does cover some services that address back pain like:
Medicare pays for medically necessary physical therapy on an outpatient basis. A doctor may recommend physical therapy to strengthen and stretch the back muscles to reduce tension and pain. The Part B deductible and coinsurance apply.
Medicare covers chiropractic services when they treat subluxation. Subluxation is when a misalignment of the spinal bones places extra strain on the nerves in the back, causing pain. Medicare Part B covers chiropractic care for subluxation up to an endorsed amount. The Part B deductible applies alongside the standard 20% coinsurance.
Medicare does not cover some back pain treatments, including:
- cold laser therapy
- massage therapy
- chiropractic treatments that do not involve spinal manipulation
Medicare sometimes expands coverage to treat some conditions in response to research and Acupuncture is one of its examples.
Chronic lower back pain is the only Medicare-approved condition for acupuncture treatment. However, a person can now use the service with a higher level of coverage than before. Those who have Medicare Advantage should check their plan to identify in-network providers and determine whether they need a doctor’s guide to seek acupuncture treatment.
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