Medicare Now Covers 12 Acupuncture Visits for Chronic Low Back Pain! Kind of....

Yes, its true! Medicare parts B and C now include Acupuncture coverage. Hooray!

Unfortunately, the benefit is a wee bit complicated. I wanted to write a little post about the basics today because I've had several patients whom I've had to turn away because they've been referred incorrectly. Since this is a new benefit we're all learning - LAc's and doctors alike - and hopefully this small missive will help avoid some confusion for all!

First off - Medicare Acupuncture benefit only covers Chronic Low Back Pain​ as defined by Medicare. Basically, this is low back pain that:

• Has been going on for at least 12 weeks
• has no known cause (i.e. no cancer, illness, injury etc., basically old age related or "mysterious" in nature)
• Is not associated with surgery or pregnancy
• NOTE that you have to sign an attestation form to this effect to use the benefit also

Second - Medicare Part B ONLY covers Acupuncture when performed by an MD or other western medical provider in said MD or medical providers office. This means the doctor can perform the Acupuncture or an LAc in the doctor's office can perform the Acupuncture while being supervised by the doctor.

Now, if you have a Medicare Part C plan, commonly called Medicare Advantage or Medicare Complete, you CAN see a Licensed Acupuncturist (like me!) independently. Said Acupuncturist has to be contracted with the insurer who administers your Medicare Part C benefits, however, such as Blue Cross Blue Shield, Kaiser, Health Net etc. 

Third - the benefit covers 12 visits in 90 days. You cannot get more time or any kind of extension on those initial 12 visits. After that, if you want more, the provider can request additional visits - usually 8-12 - by engaging in an irritating bureaucratic paperwork process that takes an indeterminate period of time.

​So, like I said, Medicare covers Acupuncture, yay!!! But... its a little confusing. If you keep this post handy, however, you shouldn't be led astray. If you have questions please don't hesitate to reach out anytime, I'd love to be of service!

Yours in health and gratitude,
​~Rebecca