Good news! Well, kind of... Medicare & Acupuncture

by Kathleen Blazek, L.Ac

     

As of January 21, 2020 the Centers for Medicare & Medicaid passed a bill to allow seniors who are on Medicare to receive acupuncture for low back pain.

The details:

Medicare Part B (Medical Insurance) covers up to 12 acupuncture visits in 90 days for chronic low back pain. Chronic low back pain is defined as:

  • Lasting 12 weeks or longer

  • Having no identifiable systemic cause (not associated with metastatic, inflammatory, or infectious disease)

  • Pain that’s not associated with surgery or pregnancy

 

An additional 8 sessions will be covered if you show improvement. No more than 20 acupuncture treatments can be given yearly. If your chronic low back pain isn’t improving or is getting worse, then treatments won’t be covered.

     

This bill allows seniors to be treated by a licensed acupuncturists with either a doctorate or a master's degree from an accredited university in Acupuncture or Chinese Medicine. So what does this mean for the millions of senior citizens on Medicare and others on Medicaid? It means that there is still some things to be worked out.

 

Over 85% of the acupuncturists in the United States are in private practice. However, CMS does not have a plan in place in order to allow practitioners of acupuncture or Chinese medicine to bill for Medicare and Medicaid patients directly. This means that in order for a Medicare/Medicaid recipient to receive acupuncture, they must go to a doctor who has a licensed acupuncturist working in their clinic. These clinics are very few, and very far between.

 

Until CMS opens up their billing systems to licensed acupuncture doctors, it is unfortunate that the majority of the senior citizens on Medicare and Medicaid will have difficulty finding a clinic within the Medicare list of authorized providers that has a licensed acupuncture practitioner working in their offices.

We acupuncturists are hopeful that CMS will come on board before the summer of 2020 to allow licensed acupuncturists to bill for treatments directly, so that all senior citizens can received the benefits due to them, including acupuncture treatments for pain.

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