Yes, both Original Medicare (Medicare Part B) & Medicare Advantage plans will often cover acupuncture treatments. However, both plans are very different.
Original Medicare/ Medicare Part B
First, Original Medicare, also referred to as Medicare Part B (medical insurance) covers up to 12 acupuncture treatments in 90 days for chronic low back pain (cLBP). Original Medicare doesn’t cover any other conditions.
If you show improvement, Original Medicare will cover an additional 8 sessions. However, if you are not showing improvement, this Medicare plan won’t cover additional treatments, and you’ll have to pay 100% of the costs if you continue getting acupuncture treatments. Assuming you are experiencing improvement, you can get a maximum of 20 acupuncture treatments in 12 months.
What Type of Providers Are Covered by Original Medicare?
Under this plan, there are many kinds of providers that can provide acupuncture if they meet all applicable state requirements.
- Physicians – A person who is trained and licensed to practice medicine. Physicians help diagnose, treat, and manage injuries, diseases, and other conditions.
- Physician assistants (PAs) are licensed medical professional who works with physicians to provide patient care.
- Nurse practitioners (NP) are registered nurses with advanced training and education who provide a range of patient care services.
- Clinical nurse specialists (CNS) are Advanced Practice Registered Nurses (APRN) prepared at a master’s, doctoral, or post-graduate certificate level.
- Auxiliary personnel: 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.
Although Licensed Acupuncturists have far more training in acupuncture than any other provider listed above, Original Medicare does not pay Licensed Acupuncturists directly for their services. The payout must go through one of the 4 provider types listed above. Hopefully, this will change in the future.
Here at Natural Medicine & Detox, Dr. Hinds, M.D., will do a consultation with patients who have chronic low back pain. If the patient qualifies for acupuncture, the patient will then see one of the Acupuncturists here, Dr. Fontes or David Garcia, under the supervision of Dr. Hinds.
Both Dr. Fontes and David Garcia have received their master’s degrees from the Phoenix Institute of Herbal Medicine & Acupuncture (PIHMA), which is a four-year intensive program. Dr. Fontes later completed his doctorate in acupuncture from Pacific College in San Diego. David Garcia is currently completing his doctorate at PIHMA. This is over five years of combined training in acupuncture and Traditional Chinese Medicine.
Original Medicare / Medicare Part B Coverage for Chronic Low Back Pain (cLBP)
Medicare defines chronic low back pain (cLBP) as pain that:
- Lasts 12 weeks or longer
- Has no identifiable systemic cause
- It is not associated with surgery or pregnancy
Spencer, Medicare Patient Testimony
“Medicare covers my acupuncture for chronic low back pain. I started at an 8 out of 10 pain level—now I’m down to a 5 after a month. David Garcia is gentle and skilled, and the staff is amazing.”
Spencer, Medicare Patient at Natural Medicine & Detox
Watch Spencer’s experience…
What are You Responsible For & How to Get Started
For Original Medicare/ Medicare Part B covered services, you usually pay 20% of the Medicare-approved amount after you meet your deductible. This amount is called your coinsurance. You’re responsible for 20% unless you have a supplemental insurance plan, in which case, it may cover the 20%.
In most cases, you do not need a referral; you just need to schedule the first appointment with Dr. Hinds, and either Dr. Fontes or David Garcia will also be present. If you live in Phoenix, Arizona, and would like to try acupuncture to help you manage or possibly eliminate your pain, please fill out our insurance form.
If you need help, call us at (602) 307-0888 and be sure to have your insurance cards. Someone from Natural Medicine & Detox will call you back to schedule your appointment with Dr. Hinds. If you are approved for chronic low back pain by Dr. Hinds, we will make your next appointment for acupuncture with either Dr. Fontes or David Garcia.
Medicare Advantage/Medicare Part C
All Medicare Advantage plans cover acupuncture for chronic low back pain that lasts at least 12 weeks. However, some other Medicare Advantage plans may cover acupuncture for other conditions, including pain in other parts of the body. If you have Medicare Advantage, it may cover arthritis, back pain, neck pain, knee pain, joint issues, muscle tension & pain, stress, headaches, migraines, and more, but there may be additional requirements:
- Last Preauthorization: Some plans may require preauthorization or a referral from your family doctor.
- In-network: HMO plans may require you to use an in-network acupuncturist.
- Deductible and copayment: A deductible and copayment may apply.
- Limited network: Some plans may require you to choose healthcare professionals from a limited network.
Each plan is different, so check your plan’s coverage rules. Licensed acupuncturists who are credentialed with insurance companies may treat patients directly and bill the insurance companies directly.
What are the out-of-pocket costs?
Out-of-pocket costs vary. Plans may have different out-of-pocket costs for acupuncture. Some plans have $0 premiums, and some have co-pays. You can contact your insurance provider to understand your coverage for your specific plan and situation.
Once you know if your plan covers acupuncture, you can fill out the insurance form, and we will verify how many visits you have and what your co-pay is, if there is any.
On the insurance form, there is a Chief Complaint question where you include what kind of pain you have, how, and when you got it. It is good to list all pain issues, including back pain if you have it. When you see one of our acupuncturists here, they will address the whole body, as well as what you have been approved for.
What Is Acupuncture?
Acupuncture is considered both a complementary and alternative medicine (CAM) technique that involves inserting thin needles into the skin at specific points on the body to treat health issues. Acupuncture is a technique where providers stimulate specific anatomical points on the body to relieve symptoms such as back pain.
While treating back pain, the acupuncturist can also address other health issues and strengthen the immune system. The practice comes from traditional Chinese medicine. In Chinese philosophy, it is supposed to help balance the energy that flows in the person’s body, often referred to as “qi,” pronounced “chi.” Acupuncture also releases endorphins and anti-inflammatory messengers.
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