Medicare Acupuncture Benefit
What is the Medicare acupuncture benefit?
New in 2020, Medicare now provides benefits for its members to receive acupuncture treatments for chronic low back pain.
How do I qualify for this benefit?
This benefit is only for low back pain that has been present for longer than three months and not clearly associated with any specific cause, (like a broken bone, recent surgery, or pregnancy) These qualifications should be easy to confirm within your medical record. You may wish to consult with your primary care physician (PCP) to review your history to see if you qualify, but a referral from your PCP is not required.
How many treatments will the benefit cover?
Medicare will pay for 8 initial treatments. If progress is confirmed, an additional 12 treatments will be covered, at just a copay, for a total of 20 treatments in one calendar year.
How much will I pay out of pocket?
In 2020, the current copay for this benefit is set at $20 per visit.
What if I already pay for the Optional Supplemental Benefit (OSB) that includes acupuncture services?
The OSB covers other conditions in addition to chronic low back pain. If you are diagnosed with chronic low back pain, your chronic low back pain benefit would be used for those particular visits and you would pay $20 per visit. This allows you to use the OSB for conditions other than chronic low back pain.
Do I need a referral to receive this benefit?
No, you do not need a referral. You may want to consult your Primary Care Physician to have them review your history and confirm you qualify for the benefit, but this is not required.
What should I expect at my first visit?
If it is your first visit for Complementary Medicine Services, your visit will be scheduled for one hour. Your provider will review your history and confirm your eligibility for the Medicare benefit. Your provider will give you a detailed introduction to the practice of acupuncture, perform a brief physical exam, and provide an initial acupuncture treatment.
How often will I need to be treated?
The Medicare benefit does not determine how often you can have treatments, but it limits the number of treatments per calendar year. There can be many factors that determine your frequency of treatments based on the nature of your back pain and your response to treatment. You will work together with your provider to determine the best treatment plan that meets your needs..
How many treatments will I need to know if it is working?
Some patients receive immediate benefits from the first treatment. Some patients require a few treatments to become comfortable with the acupuncture experience before the benefit becomes apparent. A common recommendation is to consider a trial of three treatments as an effective “trial” of acupuncture to see if you respond.