The ancient practice of acupuncture, dating back approximately 3,000 years in China, has evolved into a popular and effective non-drug and non-invasive treatment option for various health issues.
One of the significant milestones in recent times has been Medicare’s decision to cover acupuncture treatments, a change that took effect in January 2020.
Medicare Embraces Acupuncture
Previously, Medicare did not cover acupuncture; however, the Centers for Medicare and Medicaid Services (CMS) announced a policy shift to increase access to alternatives to prescription opioids.
Kimberly Brandt, CMS Principal Deputy Administrator of Operations and Policy, emphasized the importance of covering acupuncture for chronic low back pain in a press release.
Under the current policy, Medicare Part B now covers up to 12 acupuncture visits within 90 days for individuals with chronic low back pain.
Patients who show improvement during the initial 12 sessions may be eligible for an additional eight sessions, allowing for a maximum of 20 acupuncture treatments within a 12-month period.
The cost for each session is typically 20% of the Medicare-approved amount, after meeting the Part B deductible.
CMS defines chronic low back pain, which qualifies for Medicare coverage, as pain that:
- Lasts at least 12 weeks
- Has no identifiable cause associated with a disease or infection
- Is not associated with surgery or pregnancy
Acupuncture has demonstrated promising results in offering relief from a variety of health issues.
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Effectiveness and Medicare Coverage Challenges
Research shows that it is particularly effective for low back pain, which happens to be the most common reason people seek acupuncture treatments.
Studies have indicated that acupuncture provides short-term relief from chronic back pain, and its benefits can persist for up to a year after treatment ends, except for neck pain.
The precise mechanisms by which acupuncture works for back pain are not yet fully understood.
It is believed that acupuncture may directly impact the tissues where the needles are inserted and trigger the release of endorphins, which act as natural painkillers.
Despite the positive coverage change, there are certain limitations to accessing Medicare-covered acupuncture services.
Acupuncturists must be licensed and degreed and can only offer covered services if supervised by an on-staff medical doctor (MD), physician assistant (PA), nurse practitioner (NP), or clinical nurse specialist (CNS).
This requirement poses a challenge for many Medicare beneficiaries since the majority of acupuncturists work independently and lack these supervisory resources.
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