Medicare now covers Acupuncture: What to know
Following a wider acceptance of alternative treatments in the healthcare space in general, Medicare recently announced that acupuncture will now be covered under original Medicare. We wanted to take some time to explain what exactly will be covered and how much it may cost to you.
It seems as though alternative treatments are starting to become more widely adopted and recognized by “traditional” medicine. Just a couple of weeks ago we shared an article about the VA exploring outdoor therapy as an alternative treatment for PTSD. We’ve also seen a greater push towards wellness and a focus on preventive treatment in the healthcare space in general. This announcement by Medicare follows along perfectly with that trend. In fact, depending on your plan you may already have an acupuncture benefit.
As with anything with Medicare there are some caveats to consider and be aware of before you go and get your acupuncture with your Medicare card.
The first thing to be aware of is that since this is a new benefit, there is likely to be some confusion around how it works at first. Whether the confusion comes from you as the patient, the acupuncturist or Medicare itself, when rolling out a new benefit there are likely to be some hiccups. Medicare covers roughly 60 million people so when you introduce a new benefit for a group of people that large there is bound to be some confusion at first. We’re going to break down everything we know so far.
The first thing to note is that these acupuncture visits will ONLY be covered if it is intended to treat chronic lower back pain. They define chronic lower back pain as:
Lasting longer than 12 weeks
Having no known cause (not related to cancer that has spread, inflammatory, or infectious disease.)
Pain not associated with surgery or pregnancy
Another important thing to note is that Medicare will only cover up to 12 visits in a 90 day period. If the pain shows improvement because of the acupuncture they will cover an additional 8 visits at a limit of 20 covered visits per year. This means that at most, Medicare will only cover 20 visits per year.
In addition to the condition requirements needed for acupuncture to be covered there are also some things to know about who can administer acupuncture. The coverage rule states that you must receive acupuncture from a doctor or by another healthcare professional (nurse practitioner, PA, etc.) who has both of the following requirements:
A masters or doctoral level degree in acupuncture or Oriental Medicine from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine.
A current, full, active, and unrestricted license to practice acupuncture in the state where care is being provided.
The good news is that most practicing acupuncturists will already have met these requirements. However, the rule saying that it must be administered by a healthcare professional may be a limiting factor. Even though we are seeing a trend of alternative medicine being more widely adopted by traditional medicine, acupuncturist’s technically are not considered doctors based on practicing acupuncture alone. Typically you would need a degree from a Medical school for that designation of “healthcare professional.” In essence: all doctors are not acupuncturists and all acupuncturists are not doctors. You may need to do some research to find a provider who meets all the criteria. This also harkens back to our first point on the confusion folks may experience with this new benefit until all the minute details are hashed out. It may also take time to “onboard” acupuncturists to Medicare ie: allowing them to submit claims and become registered with Medicare, etc.
Another thing to note is that Medicare has not set a standard price model for acupuncture coverage as of yet. Since it is an outpatient service by definition, acupuncture should be covered under Part B. Under original Medicare this means you would pay 20% for each visit. However, if you have a Medicare supplement or Advantage plan the amount you would have to pay would most likely change. In fact, some Medicare advantage plans already include coverage for acupuncture as an ancillary benefit. You can read more about Medicare’s coverage of acupuncture here: https://www.medicare.gov/coverage/acupuncture
Again, we see this announcement as a greater trend towards wellness and alternative therapies in the healthcare space in general. We expect more of these types of announcements in the future and will be sure to update you on them as they happen. If you have a question or want to recommend a topic for us to write about next we’d love to hear from you. Please drop us a comment below or reach out to us via email: help@doctorschoiceusa.com or by phone at 401-404-7373. If you enjoy our content please share with a friend or loved one, the more the merrier. As always, thanks for reading!
Source: https://www.medicare.gov/coverage/acupuncture