What Medicare covers for acupuncture

Medicare Part B covers acupuncture for chronic lower back pain only. If you have arthritis in your lower back, you may be covered. If your arthritis is in your hands, knees, hips, or neck, Medicare does not cover acupuncture for it.

The coverage applies to chronic lower back pain that has lasted at least 12 weeks. You must see a doctor first who confirms the diagnosis and refers you to an acupuncturist. Medicare will pay 80% of the cost after you meet your Part B deductible for the year.

The acupuncturist must be a licensed acupuncturist, physician, or other may have access to practitioner in your state. Not all acupuncturists are enrolled in Medicare, so you will need to check before scheduling.

Key Takeaways

  • Medicare Part B covers acupuncture only for chronic lower back pain that has lasted at least 12 weeks, not for arthritis in other joints.
  • You need a doctor's referral and diagnosis before Medicare will cover acupuncture treatment.
  • Medicare pays 80% of the cost after you meet your annual Part B deductible, and you pay the remaining 20%.
  • The acupuncturist must be licensed and enrolled in Medicare to bill your coverage.
  • If your arthritis is not in your lower back, you would pay the full cost out of pocket unless your Medigap or Medicare Advantage plan covers it.

How to get a referral from your doctor

Start by telling your primary care doctor or rheumatologist that you are interested in acupuncture for your lower back pain. Your doctor will examine you and review your medical history to confirm that your pain is chronic (lasting at least 12 weeks) and that acupuncture is appropriate for you.

If your doctor agrees, ask for a referral to an acupuncturist. Your doctor does not need to refer you to a specific person, but they should document in your medical record that acupuncture has been recommended. Keep a copy of this referral or note for your records.

Before you schedule, call the acupuncturist's office and confirm that they accept Medicare and that they are enrolled as a Medicare provider. Some acupuncturists do not accept Medicare even if they are licensed, so this step saves you from arriving for an appointment you cannot use.

What you will pay out of pocket

Your out-of-pocket cost depends on whether you have met your Part B deductible for the year. The Part B deductible changes each year. Once you have paid the deductible, Medicare covers 80% of the acupuncturist's fee, and you pay 20%.

The actual cost per session varies by location and provider. Ask the acupuncturist's office for their Medicare fee before your first appointment so you know what your 20% share will be. Some offices can tell you this over the phone.

If you have a Medigap plan (supplemental insurance), it may cover some or all of your 20% coinsurance. If you have a Medicare Advantage plan, check your plan documents or call the plan to see whether acupuncture is covered and what your copay or coinsurance will be.

Acupuncture for arthritis in other joints

Medicare does not cover acupuncture for arthritis in your hands, wrists, elbows, shoulders, hips, knees, ankles, or neck. If you want acupuncture for these areas, you would pay the full cost yourself unless your Medigap or Medicare Advantage plan covers it.

Some Medicare Advantage plans do cover acupuncture more broadly than Original Medicare does. If you are in a Medicare Advantage plan, call your plan to ask what acupuncture coverage you have and whether a referral is required.

If you are in Original Medicare and want acupuncture for arthritis outside the lower back, you can still receive it — you straightforward pay the full fee. Some acupuncturists offer reduced rates for uninsured or out-of-pocket patients, so it is worth asking.

How many sessions Medicare will cover

Medicare covers up to 20 acupuncture sessions in the first 12 weeks of treatment, then up to 10 more sessions after that if your doctor determines you are improving. The total is 30 sessions per year.

Your acupuncturist will need to document your progress and report it to Medicare. If you are not showing improvement after the first 20 sessions, Medicare may not cover additional sessions. Your doctor and acupuncturist work together to determine whether to continue.

If you reach the 30-session limit in a calendar year, you would need to pay out of pocket for any additional sessions. The limit resets on January 1st each year.

Finding a Medicare-enrolled acupuncturist

Use the Medicare Provider Lookup tool on Medicare.gov to search for acupuncturists in your area who are enrolled in Medicare. You can search by your zip code and the type of provider.

You can also ask your doctor for a referral to someone they know accepts Medicare. Your local hospital or rheumatology clinic may have a list of acupuncturists they work with.

When you call an acupuncturist's office, ask three things: whether they accept Medicare, whether they are currently accepting new Medicare patients, and what their Medicare fee is per session. Some practices are full and not taking new patients, so it is worth checking before you spend time on paperwork.

What happens if your arthritis is not in your lower back

If your arthritis is in your knee, hip, shoulder, or another joint outside the lower back, Medicare Part B will not cover acupuncture. You have three main options: pay out of pocket, check whether your supplemental or Medicare Advantage plan covers it, or explore other treatments your doctor recommends.

Other treatments that Medicare does cover for arthritis include physical therapy, occupational therapy, and certain medications. Your doctor can refer you to physical therapy without needing to try acupuncture first. Some people find that physical therapy, exercise, and weight management reduce arthritis pain significantly.

If you want to try acupuncture anyway, you can pay the full cost. Prices vary widely by region and provider, typically ranging from $50 to $150 per session, but this varies. Some acupuncturists offer package discounts if you pay upfront for multiple sessions.

Frequently Asked Questions

Does Medicare cover acupuncture for knee arthritis?

No. Medicare Part B covers acupuncture only for chronic lower back pain. Knee arthritis is not covered. If you have a Medicare Advantage plan, check your plan documents or call to see whether your plan covers acupuncture for knee pain.

Do I need my doctor to refer me, or can I just call an acupuncturist?

You need a doctor's referral and diagnosis. Medicare requires that your doctor confirms you have chronic lower back pain lasting at least 12 weeks and that acupuncture is appropriate for you. Without this documentation, the acupuncturist cannot bill Medicare.

What if the acupuncturist is not enrolled in Medicare?

If the acupuncturist is not enrolled in Medicare, they cannot bill Medicare for your treatment. You would pay the full cost out of pocket. Some non-enrolled acupuncturists charge less than Medicare rates, so it may be worth comparing costs, but you will not receive any Medicare reimbursement.

Can I use my Medigap plan to cover acupuncture for arthritis in my knee?

Medigap plans follow Medicare's coverage rules. If Medicare does not cover acupuncture for your knee, your Medigap plan will not either. However, some Medicare Advantage plans have different coverage, so check your plan if you are in one.

How do I know if I have met my Part B deductible?

Your Medicare Summary Notice (the statement you receive quarterly) shows how much of your deductible you have met. You can also log into your Medicare.gov account and check under "Claims" to see your deductible status. Call Medicare at 1-800-MEDICARE if you cannot find this information.