Understanding Medicare coverage for acupuncture can be confusing due to legal restrictions and varying policies among different insurance providers. Here’s what you need to know about how acupuncture is billed under Medicare and what coverage options are available.
Medicare Does Not Allow Acupuncturists to Bill Directly
A law passed by Congress prohibits licensed acupuncturists from filing claims directly with Medicare. Instead, acupuncture services must be billed through a Third Party Supplement company if the patient has one. This creates challenges because each supplement plan has different rules regarding acupuncture coverage.
At Raleigh Acupuncture, we work with patients to navigate this complex system and maximize coverage wherever possible. However, due to Medicare’s restrictions, direct billing is not an option for independent acupuncture providers.
Acupuncture Coverage Through Medicare Advantage Plans
While Original Medicare does not cover acupuncture from licensed acupuncturists, some Medicare Advantage plans (Part C) do provide benefits. At Raleigh Acupuncture, we are In-Network with United Healthcare and Aetna, which means we can often get acupuncture claims covered under their Medicare Advantage plans. Here are some details about Medicare coverage for acupuncture:
United Healthcare Medicare Advantage & Aetna Medicare: We can typically file claims for these plans and receive payment.
United Healthcare AARP Medicare Advantage: This plan often denies claims for acupuncture. However, if you appeal the denial, they sometimes approve payment upon reconsideration.
Humana Medicare Advantage: This plan only covers acupuncture for retired North Carolina State employees. If you are not a retired state employee, Humana will not pay for acupuncture services.
No Coverage from Other Medicare Supplement Plans: Unfortunately, most other Medicare Supplement (Medigap) plans do not cover acupuncture services. This includes supplemental plans from Blue Cross Blue Shield, Cigna, and many others. If you have a supplement plan, it is unlikely that acupuncture will be reimbursed.
The Challenges of Medicare Acupuncture Coverage
The inconsistent nature of Medicare coverage for acupuncture is frustrating. Some plans provide benefits, while others deny claims or require lengthy appeals. Even when a plan covers acupuncture, reimbursement is not always guaranteed.
At Raleigh Acupuncture, we understand these challenges and will do our best to assist you in obtaining coverage. We will file claims with the appropriate third-party insurers and help guide you through the appeal process when necessary.
What You Can Do
If you are considering acupuncture and have a Medicare Advantage plan, we recommend:
1. Calling your insurance provider to confirm whether they cover acupuncture and under what conditions.
2. Checking if your plan requires pre-authorization for acupuncture treatments.
3. Being prepared to appeal a denial if you have United Healthcare AARP Medicare Advantage.
For patients with Medicare Supplement plans that do not cover acupuncture, we offer affordable self-pay options to ensure you can still receive the care you need.
If you have any questions about acupuncture coverage under Medicare, please contact Raleigh Acupuncture, and we will be happy to assist you in understanding your options. Be aware that laws change frequently and the information contained in this FAQ might be outdated by the time you read it. Feel free to contact us for up-to-date information on Medicare coverage for acupuncture.
About Raleigh Acupuncture
At Raleigh Acupuncture Associates, we are deeply committed to providing the highest quality professional acupuncture while being rooted in strong Judeo-Christian values of love, faith, kindness, and truth. We guide our practice with compassionate care, where each patient is treated with respect and dignity, regardless of their background, faith, or beliefs. We welcome people from all walks of life and strive to create a warm, inclusive environment promoting healing and holistic wellness. Our dedication to delivering exceptional acupuncture is paired with a genuine love for helping others, making our clinic a place where faith and professional medical care come together for the well-being of every patient.
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