Medicare Part B now offers acupuncture for low back pain. The problem is that acupuncturists are not allowed to file claims directly to Medicare. As a result, most seniors are unable to take advantage of this benefit.
Medicare Acupuncture Back Pain Benefit
The following is the exact language of the Medicare acupuncture back pain benefit from Medicare’s website (https://www.medicare.gov/coverage/acupuncture):
Medicare Part B (Medical Insurance) covers up to 12 acupuncture visits in 90 days for chronic low back pain.
Medicare covers an additional eight sessions if you show improvement. If your doctor decides your chronic low back pain isn’t improving or is getting worse, then Medicare won’t cover your treatments. No more than 20 acupuncture treatments can be given yearly.
Medicare doesn’t cover acupuncture (including dry needling) for any condition other than chronic low back pain.
What it is
Acupuncture is a technique where practitioners stimulate specific points on the body, most often by inserting thin needles through the skin.
Things to know
Chronic low back pain is defined as:
Lasting 12 weeks or longer
Having no known cause (not related to cancer that has spread, inflammatory, or infectious disease)
Pain not associated with surgery or pregnancy
You must get acupuncture from a doctor, or by another health care provider (like a nurse practitioner or physician assistant) who has both of these:
- 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.
Current Benefit Situation
At Raleigh Acupuncture, we have figured out a way for some Medicare patients to receive this Medicare acupuncture back pain benefit. Their claims get paid when we submit them to third-party supplemental health insurance companies in which we are in-network, including United Healthcare Medicare Advantage and Aetna Medicare.
However, when we submit claims to any other third-party plans where we are not in-network, the Medicare acupuncture back pain benefit claims are denied.
Acupuncturists Not Allowed To File Claims With Medicare
At this time, acupuncturists are not allowed to file claims directly with Medicare. We are not issued Medicare Numbers and have no way to submit our patients’ claims to the government legally. So we are forced to use third-party vendors.
Medicare Specifically Requires Treatment From Acupuncturists
Medicare’s language on their website specifically requires that a properly trained acupuncturist perform acupuncture. The Medicare acupuncture back pain benefit MUST be from a healthcare practitioner who has both:
- 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 provided.
This requirement is a good thing, as it protects seniors and guarantees that a Nationally Board certified acupuncturist performs the care they get.
However, the government needs to enable acupuncturists to file claims directly with Medicare. Until this happens, seniors will not be able to utilize this excellent benefit.
If you are a senior on Medicare and have a supplemental plan with either United Healthcare or Aetna, you can currently receive the Medicare acupuncture back pain benefit. If you do not have either of these plans, we suggest you call your Member of Congress and explain your situation. We must resolve this issue at the Federal level of government.
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What our Clients are Saying
I came to Raleigh Acupuncture. After 1 treatment, my back felt better than it has in a year. I’ve had acupuncture before elsewhere and it has never been this effective.
I went in for a bulging disc in my back and a couple of days after the first treatment I had no pain in my back. Before treatment I had a constant dull pain in the middle of my back when at rest. The treatments were about a week apart and I completed 3 of them. It has been about 3 weeks since I have been and have a slight pain in my back but is nowhere near what it was before I started treatment. Before getting acupuncture I tried chiropractic and felt worse when I was done. For those that are skeptical like me, let me tell you that it works. I would definitely recommend Dr Mark in his ability to help with your pain.
I suffered from low back pain for years and tried many different remedies. When I came to Raleigh Acupuncture, they really listened to understand my issues. I can honestly say that they cured my chronic back pain. I didn’t think it was possible, after all these years. I highly recommend this practice. The doctors take the time and do good work.