Does Medicare Cover Acupuncture?

If you’re one of the estimated 50 million Americans living with chronic pain, you may be wondering about your treatment options. A growing number of people are turning to acupuncture, a component of traditional Chinese medicine that involves stimulating specific points on the body with thin needles to find relief. 

Approximately 3.5 million U.S. adults get acupuncture annually, and evidence shows it may be particularly helpful for back pain.

However, since many still consider acupuncture an alternative medicine, coverage by insurance plans varies widely. For those 65 and older, a key question is: Does Medicare cover acupuncture? 

The short answer is, in some cases, yes. As of January 2020, Medicare Part B covers up to 12 acupuncture sessions in 90 days for chronic low back pain. If pain improves, an additional eight sessions may be covered. However, patients need to be aware of specific rules and limitations to this coverage.

In this article, we’ll explain everything you need to know about Medicare’s acupuncture benefits. We’ll explain exactly what’s covered, the provider credentials required, how much you can expect to pay, and how to find acupuncturists who accept Medicare. We’ll also explore why Medicare doesn’t cover acupuncture more broadly and offer helpful resources for navigating your care.

Medicare’s Acupuncture Coverage

Is acupuncture covered by insurance? As of January 2020, Medicare Part B covers acupuncture to treat chronic low back pain. Original Medicare will pay for this treatment if you meet certain criteria. Medicare Advantage Plans are also required to provide this same coverage.

To be eligible, you must have chronic low back pain, which is defined as:

• Lasting 12 weeks or longer.
• Having no identifiable systemic cause (i.e., not associated with metastatic, inflammatory, or infectious disease). 
• Not associated with surgery or pregnancy.

If you meet these criteria, Medicare will cover up to 12 acupuncture sessions in 90 days. If your doctor determines that your chronic low back pain is improving, you may be eligible for an additional eight sessions for a total of 20 treatments per year. 

However, if your pain is not improving or worsening, Medicare will not continue to cover your treatments. It’s important to track your progress and communicate your results openly with your healthcare providers.

It’s also critical to note that Medicare will only specifically cover acupuncture treatments for low back pain. If you are seeking acupuncture for other conditions like osteoarthritis, migraines, or fibromyalgia, Original Medicare will not provide coverage. (Some Medicare Advantage plans may offer expanded benefits, but more on that later.)

This limited coverage is part of Medicare’s efforts to offer more non-pharmacological options for pain management in light of the opioid epidemic. By covering alternative therapies like acupuncture in targeted ways, Medicare aims to give beneficiaries more tools to manage pain safely and effectively.

What Are the Requirements for Medicare Coverage?

Does Medicare cover acupuncture for chronic low back pain, and what are the specific requirements for coverage? For acupuncture to be covered by Medicare, it must be offered by a healthcare provider meeting specific qualifications. These include:

1. Having 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).
2. Holding a current, full, active, and unrestricted license to practice acupuncture in the state where care is being provided.

This means that your acupuncturist must be properly trained and credentialed for Medicare to cover your care. It’s important to check that your provider meets these requirements before beginning treatment.

Regarding cost-sharing, patients are responsible for 20% of the Medicare-approved amount for covered acupuncture services after meeting their Part B deductible. In 2024, the standard Part B deductible is $226.

Example Cost Breakdown

Here’s an example of how that might look:

Let’s say the Medicare-approved amount for an acupuncture session is $100. If you’ve already met your Part B deductible, you would pay 20% of that, or $20. Medicare would pay the remaining 80%, or $80. 

If you have a Medigap policy or other supplemental coverage, that may help cover your out-of-pocket costs. Checking with your insurance provider about your specific plan’s benefits is a good idea.

While everyone prefers a treatment with no out-of-pocket expense, Medicare covering 80% of treatment costs can still make acupuncture much more affordable and accessible to those who need it. Being aware of these cost-sharing requirements can help you plan and budget for your care.

Does Medicare Cover Acupuncture for More Conditions?

While Medicare’s decision to cover acupuncture for chronic low back pain is a significant step, many seniors may wonder why coverage isn’t provided more broadly. After all, a growing body of research supports acupuncture’s effectiveness for a range of painful conditions common in older adults.

For instance, a systematic review published in the journal Headache found that acupuncture reduced the frequency of migraine headaches compared to sham acupuncture or no treatment. A 2018 network meta-analysis of 16 trials found that electroacupuncture improved pain and function compared to sham acupuncture, educational interventions, and wait-list controls for patients with knee osteoarthritis.

So with all this encouraging evidence, why hasn’t Medicare expanded coverage? The answer lies in the strength and consistency of the research. While studies point to acupuncture’s benefits for various conditions, Medicare has determined insufficient evidence to support broader coverage. 

Factors like small sample sizes, lack of long-term follow-up, and variability in acupuncture techniques have made it challenging to draw firm conclusions.

As a result, seniors seeking acupuncture for conditions other than chronic low back pain will likely need to pay out of pocket. Costs can vary based on location and provider; you can expect to be charged between $90 and $200 for the initial visit and likely lower for follow-up appointments. 

These costs can add up quickly, especially for those on a fixed income. However, some seniors may find the potential benefits worth the investment, particularly if other treatment options have been ineffective. 

As always, it’s important to discuss the potential risks, benefits, and costs of any treatment with your healthcare providers to determine the best approach for your individual needs and circumstances.

How to Find Medicare-Covered Acupuncture Providers

If you could benefit from acupuncture for chronic low back pain, the next step is finding a qualified provider. Here’s how to search for acupuncturists that accept Medicare:

1. Go to Medicare.gov and click on “Find care providers” under the “What do you need help with?” section.
2. Choose “Doctors & clinicians” and enter your zip code or city and state. 
3. In the search box, enter “acupuncturist” or “acupuncture.” 
4. From the list of results, you can see each provider’s name, address, phone number, and whether they accept Medicare assignment (meaning they agree to Medicare’s approved amount as full payment).
5. You can also call 1-800-MEDICARE and follow the prompts for help locating a provider.

In addition to Medicare’s directory, your state or local acupuncture society may maintain a list of licensed providers. You can also check with acupuncture schools in your area, as they may offer reduced-cost treatments in student clinics overseen by experienced practitioners.

Questions to Ask Before Your First Acupuncture Appointment

When contacting a provider, be sure to ask:

• Are you a licensed acupuncturist? 
• Do you have a master’s or doctoral degree in acupuncture from an accredited school?
• Do you accept Medicare assignment?
• Have you treated other patients with chronic low back pain?
• Will Medicare cover acupuncture treatment?

Getting satisfactory answers to these questions can help ensure you’ve found a qualified provider to begin your treatment.

Acupuncture and Medicare

Living with chronic pain can be challenging, affecting all aspects of daily life. For those dealing with persistent low back pain, acupuncture may offer a safe, effective path to relief. And thanks to Medicare’s decision to cover acupuncture for this condition, more seniors can access this promising treatment affordably.

To recap, Medicare Part B (and Medicare Advantage plans) covers up to 12 acupuncture sessions in 90 days for chronic low back pain, with an additional 8 sessions covered if pain improves. Treatments must be provided by an acupuncturist with a master’s or doctoral degree from an accredited school and an active license. Patients are responsible for 20% of the Medicare-approved cost after meeting their Part B deductible.

While coverage is not provided for other painful conditions at this time, ongoing research continues to explore acupuncture’s therapeutic potential. Many patients report significant, lasting pain relief that allows them to engage more fully in the activities they enjoy.

If you’re experiencing chronic low back pain that hasn’t responded to other treatments, consider talking to your doctor about whether acupuncture could be right for you. With a better understanding of Medicare’s coverage and resources for finding qualified providers, you’re well-equipped to take the next step on your journey to better health and quality of life.