Does Medicaid Cover Acupuncture – Nearly 28% to 48% of adults in the United States of America are experiencing lower back pain. If you are one of them and haven’t seen any results from conventional medical procedures or treatments you may be considering alternative and effective therapies. One of the most popular options that helps to relieve lower back pain is acupuncture. The American College of Physicians suggested acupuncture to be one of the best steps for those who want to lower back pain and improve their overall quality of life.
A lot of people wonder ‘Does Medicaid Cover Acupuncture’ and help reduce pain. Fortunately, Medicare Part B covers a limited number of sessions to treat lower back pain. If you’re enrolled in Medicare or Medicaid then you can obtain your acupuncture coverage depending on your eligibility and other factors. Medicare Part B is one of them that covers an unlimited number of sessions to treat lower back pain.
In this comprehensive guide, we will help you tell people into the following topics:
- What is acupuncture?
- Does Medicaid have acupuncture?
- Do Medicare Advantage plans cover acupuncture?
- How to find an acupuncture clinic near you that access Medicare/ Medicaid?
- What are the eligibility criteria and documentation requirements to cover acupuncture through Medicaid or Medicare?
Highlights of this Post
Key Takeaways
- Medicare Part B offers coverage for up to 20 acupuncture sessions per year for chronic low back pain.
- Medicaid coverage for acupuncture varies by state and typically applies only to chronic lower back pain treatments.
- Acupuncture is recognized as a beneficial treatment for multiple conditions, including back pain, knee pain, allergies, and migraines.
- Costs without insurance range from $50 to $175 per session, with initial treatments generally being more expensive.
- Eligibility for acupuncture coverage through Medicare or Medicaid requires a prescription and proof of chronic lower back pain lasting 12 weeks or more without an identifiable underlying cause.
What Is Acupuncture?
Acupuncture is a needle penetration technique or an alternative healing therapy based on old Chinese medicine. The procedure requires an acupuncturist to insert tiny thin needles into the skin at particular points across your body for stimulating the central nervous system. For a unique and holistic approach, acupuncture treatment helps to balance the body’s energy flow called Qi and comes with many health benefits from pain management to stress relief.
Research and studies have revealed that this technique helps people to manage chronic back pain and live an improved quality of life. It is a safe treatment for a variety of health conditions, including symptoms and diseases such as back pain, nausea and cancer treatment.
As per reports of the National Institute of Health, acupuncture treatment helps people to get relief from the following conditions:
- Knee pain or osteoarthritis
- Seasonal allergies
- Stress
- Cancer-associated signs and side effects for instance vomiting and fatigue
- Migraines
- Neck pain
- Back pain.
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How Much Does Acupuncture Cost?
The cost of acupuncture may vary according to the insurance provider and your state of residence. The first appointment can be a bit expensive for you as you need to pay for the consultation fee and the treatment. Medicare has not yet issued the accurate amount that they pay for the acupuncture treatment.
Once the fee gets established, you can pay for 20% of the fee and your Part B deductible. Without insurance, you have to pay around $100 or more for the initial treatment and $50 to $175 for follow-up treatment. Acupuncture rates may vary, so you need to ask your practitioner how much each session will cost. To be covered by Medicare or Medicaid an acupuncturist must meet the requirements and agree to accept Medicare or Medicaid payment.
Does Medicaid Cover Acupuncture?
Medicaid is a joint federal and state program that offers health coverage for low-income individuals, and may offer acupuncture coverage depending on your state of residence. You must contact your state Medicaid program to get comprehensive treatment and acupuncture coverage. Medicaid covers acupuncture but only for treatment of chronic lower back pain.
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Does Medicare Cover Acupuncture?
Medicare Part B for medical insurance covers acupuncture only for the treatment of chronic low back pain that is defined by Medicare as a condition lasting 12 weeks or more, having no particular cause and having pain not associated with pregnancy or surgery.
The Centers for Medicare and Medicaid Services (CMS) announced on January 21, 2020, that it would provide coverage for acupuncture services to help people get treatment for their chronic lower back pain. Earlier Medicare did not provide coverage for acupuncture to treat any health condition.
Only the Medicare Part B program covered these services as these are part of non-hospital medical treatments.
As per the new change in policy that was in effect from January 2020, the agency stated that Medicare coverage will be for 12 sessions in 90 days. Along with an additional eight sessions if the recipient experiences improvement in their condition. Based on the available research about the prevailing effects of acupuncture treatments, Medicare will provide coverage for up to 20 sessions across one year.
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How Much Acupuncture Coverage Will You Get From Medicare?
As you know, Medicare Part B will cover up to 12 acupuncture sessions in 90 days, and if your condition improves, Medicare will approve your 8 more visits for a maximum of 20 treatments in 12 months. But in case your condition worsens, Medicare will not approve any more sessions. Once you meet your Part B deductible your medical coverage will start.
Part B will cover 80% of the Medicare-approved amount for every acupuncture session, where you have to pay the remaining 20% directly out of your pocket or through Supplemental insurance such as Medigap plans. These coverage guidelines will apply to private Medicare Advantage or Part C plans.
Typically, Medicare Advantage plans are required to offer all benefits that are included in original Medicare, such as Part A and Part B. A few Medicare Advantage plans provide expanded acupuncture coverage. For instance, the CareFirst Blue Cross Blue Shield encompasses routine acupuncture treatments in its Medicare Advantage plan, whereas United Healthcare Medicare Advantage plans cover acupuncture for nausea and pain relief.
Medicare Advantage plans may vary in different states, so you can learn comprehensive details of your plan by contacting your insurance provider or your state health insurance assistance program.
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What Are The Eligibility Criteria To Get Acupuncture Coverage Through Medicaid or Medicare?
To obtain acupuncture coverage, You need to fulfill certain eligibility criteria that may differ depending on your state’s provision for the Medicare program. However, the following are the common factors that are required.
- Must receive treatment from a credentialed physician, advanced practice provider or nurse practitioner who meets the following Medicare requirements:
- Should hold a master’s or doctoral degree in oriental medicine or acupuncture from a school that has been acquitted by the Acaom Accreditation Commission For Acupuncture And Herbal Medicine.
- Must possess an unrestricted and valid license for practicing acupuncture in the state from where you are seeking the treatment.
- Must experience chronic lower back pain. According to the CMS, chronic lower back pain is a condition that lasts three months or more and doesn’t have a particular cause like, certainly, disease or pregnancy.
- Must be enrolled in the Medicare or Medicaid program from which you are seeking acupuncture coverage.
- Healthcare providers must document your condition and certify the medical necessity of acupuncture for the treatment of your chronic low back pain.
- The beneficiaries must receive equal services from approved providers to qualify for coverage. The Medicare coverage for acupuncture is specific to chronic low back pain, while other conditions remain limited.
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What Are The Documentation Criteria To Get Acupuncture Coverage Through Medicaid Or Medicare Program?
To get acupuncture coverage under the Medicare program you need to provide certain documents and follow specific procedures such as the following:
- Must provide detailed medical history or relevant diagnostic tests from your healthcare professional detailing why acupuncture is a medically necessary treatment for your condition.
- Documents from your acupuncture including the contact information, credentials and certification showing that they are a licensed provider
- Complete Medicare or Medicaid claim forms if you are filing a claim directly, and this can be obtained from your Medicare or Medicaid office or from your acupuncturist office.
- Use a Medicare or Medicaid card to make sure you are a recipient of these health insurance programs.
- Proof of identity in the form of Social Security cards, passport or government-issued ID
- Referral from your specialist or healthcare professional indicating acupuncture is needed as a part of your treatment plan.
How To Access Acupuncture Services Through Medicaid or Medicare?
To access acupuncture coverage through Medicare insurance services, you need to follow the below-mentioned steps carefully:
- The first step is to discuss your issue of chronic low back pain with your healthcare provider and find out if acupuncture is the right treatment option for you.
- Your healthcare provider can offer referral or certification for acupuncture services that are needed and deemed medically necessary depending on your condition
- Make sure you’ve chosen an acupuncturist who is participating and has been approved by the Medicare program. Only Medicaid and Medicare-approved acupuncture is supposed to be covered by the insurance programs.
- The acupuncturist must submit claims for the services to Medicare or Medicaid and detail the medical necessity.
- Recipients of the Medicare or Medicaid program must be aware of out-of-pocket costs associated with acupuncture covered by Medicare Medicaid, including coinsurance and deductibles.
Why Doesn’t Medicare or Medicaid Cover Acupuncture For Other Health Conditions?
Medicare or Medicaid coverage for acupuncture is limited only to chronic low back pain. Even though research states that acupuncture helps to relieve angina, migraines and other health conditions, the effectiveness of the practice outside of lower back pain is considered unclear and patchy.
The Medicare administrators considered acupuncture coverage for osteoarthritis; however, the evidence proved insufficient.
The CMS has ruled that the acupuncture technique for osteoarthritis was not necessary and reasonable. Therefore trying acupuncture as a means of treatment for anything other than chronic lower back pain will require you to pay out of pocket.
The cost of acupuncture treatment may vary, but a study in 2019 revealed that the average cost of the treatment is $112 for the first session with $80 for a follow-up visit. The coverage expansion may change in the future as more medical evidence and updates on acupuncture’s efficacy for different conditions come up.
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Do Medicare Advantage Plans Cover Acupuncture?
One of the best alternatives to the Original Medicare program is the Medicare Advantage or Part C plan. If you’re enrolled with this plan, you can pay a private insurance company for Medicare Part A, B &D. The coverage includes medical care, hospital care and prescription drugs. A few people can also choose additional services like eye or dental care.
The Medicare Advantage plans offer similar coverage as of original Medicare including medical treatments and procedures. Therefore it is expected that the program will also cover acupuncture to treat lower back pain. A few Medicare Advantage plans may also expand acupuncture coverage to treat other health conditions, but copayments and deductibles can apply.
Many Medicare Advantage require people to choose a doctor from a limited network and requirements that can extend to acupuncture professionals. Other plans may require the doctor’s healthcare professional to refer recipients to acupuncture professionals before Medicare covers the costs.
Those with Medicaid contact plans must contact their insurance provider to get a comprehensive list of in-network healthcare professionals along with clarity on the level of acupuncture coverage that they can expect. If you have any questions or queries about Medicare, then you can visit the medicare.gov website or contact 800-Medicare (800-633-4227, TTY 877-486-2048).
Which Insurance Companies Cover Acupuncture With Medicare or Medicaid?
The Medicare Advantage is one of the alternatives to traditional Medicare offered by private health insurers. It covers the same benefits as Medicare Part A and Part B. Following is the list of insurance companies that help to shop for Medicare and Medicaid plans:
United Healthcare
- States available: 49 States including Washington DC
- Contact: 855-821-0556/ TTY 711.
Humana
- States available: 49 states including Washington DC and Puerto Rico
- Contact: 855-432-0512 / TTY 711.
If you want to use the Medicare Part C or supplemental plan, you need to visit a medical doctor, nurse practitioner who is a licensed acupuncturist, an acupuncture supervised by a medical doctor and a chiropractor who is also a licensed acupuncturist.
Presently, acupuncturists can’t bill Medicare Part B supplemental plans directly, but they can do so under a medical doctor’s supervision. Licensed acupuncturists are allowed to bill Medicare Advantage plans or Medicare Part C plans directly.
Conclusion
To sum up, acupuncture is an ancient and holistic practice that is growing in popularity in the modern healthcare sector. Those who are wondering ‘Does Medicaid Cover Acupuncture’ would be pleased to note that both Medicare and Medicaid insurance services provide acupuncture coverage. However, the services coverage and benefits may vary depending on your state of residence. Medicare and Medicaid will cover acupuncture when administered by enrolled qualified healthcare professionals only. By understanding the aforementioned eligibility criteria, documentation requirements, and application process, you can definitely access acupuncture services through the Medicare or Medicaid program and improve your quality of life.
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Frequently Asked Questions
Does Medicare Cover Acupuncture Performed By Chiropractor?
Yes, Medicare can cover acupuncture when administered by an enrolled and qualified healthcare professional, including a chiropractor, provided he or she meets the Medicare standards.
Does Medicare Pay For Acupuncture For Anxiety?
No, as of now, acupuncture coverage by Medicare or Medicaid Services specific to chronic low back pain only and do the coverage for anxiety is not included. Acupuncture can be claimed on Medicare or Medicaid if it is deemed medically necessary for the treatment of lower back pain.
What Parts Of Medicare Pay For Acupuncture?
Acupuncture for relieving chronic lower back pain is covered under Part B if the beneficiary is enrolled on original Medicare. It is covered by Medicare Part B for up to 12 sessions in 90 months and can be extended for another 8 visits if the situation improves. There is a limit of 20 acupuncture treatments per year.
How Much Does Acupuncture Cost In the USA?
The national average cost of an acupuncture session in America ranges between $75 to $125 per session. The price may vary depending on the location, the services provided, and the practitioners’ experience.
