Medicare Will Now Cover Acupuncture for Low Back Pain

As of January 21st, the Center for Medicaid and Medicare Services (CMS) announced that acupuncture to treat low back pain will now be a covered benefit under section 1862(a)(1)(A) of the Social Security Act. 

The benefit will encompass up to 12 visits within 90 days for covered Medicare beneficiaries if they meet the following criteria. Chronic low back pain (cLBP) is defined in their terms as pain that:

Medicare Will Now Cover Acupuncture
  • Lasts 12 weeks or longer;

  • Is nonspecific, meaning that there is no diagnosis of a metastatic, inflammatory, infectious, etc. disease)

  • Is not associated or resulted from from surgery or pregnancy

On top of the initial 12 visits within 90 days, a patient may also be eligible for eight more sessions for those patients who are demonstrating a marked improvement in their symptoms. However, a maximum of 20 treatments may be administered a covered benefit per year.

And, if a patient is not showing signs of improvement or worse, is somehow regressing, their treatment must be discontinued.

The treatment must also only be performed by a qualified provider CSA defines qualified providers as: “Physician assistants, nurse practitioners/clinical nurse specialists (as identified in 1861(aa)(5)), and auxiliary personnel” that meet all applicable state requirements and have:

  • Masters or doctoral-level degree in acupuncture or Oriental Medicine from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine (ACAOM); and

  • current, full, active, and unrestricted license to practice acupuncture in a State, Territory, or Commonwealth (i.e. Puerto Rico) of the United States, or District of Columbia.

Finally, the announcement states, “Auxiliary personnel furnishing acupuncture must be under the appropriate level of supervision of a physician, physician assistant, or nurse practitioner/clinical nurse specialist required by our regulations at 42 CFR §§ 410.26 and 410.27.”

To find out exactly what this means for you, call us today to see what benefits you may have under your insurance and if acupuncture is considered a covered benefit for you. If not, don’t fret! We also offer affordable cash rate options for those without coverage — so that healthy healing is accessible to all.

What You Should Know About Acupuncture and Low Back Pain

Back pain is, unfortunately, something that affects so many of us — specifically low back pain.

It can range from an annoying ache to debilitating, mobility limiting pain that seems to flare up at the worst times. And if you’re suffering, you’re not alone.

In fact, here are some alarming statistics from the American Chiropractic Association:

Worldwide, back pain is the single leading cause of disability, preventing many people from engaging in work as well as other everyday activities.2

  • Back pain is one of the most common reasons for missed work. One-half of all working Americans admit to having back pain symptoms each year. In fact, it accounts for 264 million lost workdays in one year—approximately two workdays for every full-time worker in the country.

  • Experts estimate that up to 80% of the population will experience back pain at some time in their lives.

  • Back pain is the third most common reason for visits to the doctor’s office, behind skin disorders and osteoarthritis/joint disorders.

  • Most cases of back pain are mechanical or non-organic—meaning they are not caused by serious conditions, such as inflammatory arthritis, infection, fracture or cancer.

  • Low-back pain costs Americans at least $50 billion in health care costs each year and when you factor in lost wages and decreased productivity, that figure rises to more than $100 billion.

Shocked?

We aren’t. We treat back pain every single day, and we can help you too.

With proper treatment, acupuncture can trigger the release of endorphins and other pain-relieving hormones (endorphins) to help calm the nerves. It can also help to calm and relax you, thus relaxing any tense muscles or spasms that are caused by the pain.

Acupuncture will also rebalance your qi, and promote healthy blood flow to the areas of your body that need it the most.

Come in today for a free consultation, and be on your way to improvement in no time.