Medicare Will Now Cover Acupuncture for Low Back Pain

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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.