Up to 12 sessions in a 90-day period additional eight sessions covered for individuals demonstrating improvement no. However this is changing.
New Acupuncture Benefits For Medicare Enrollees
CMS believes that sufficient clinical research shows the functional benefits of acupuncture in the alleviation of pain and the restoration of function for those suffering with cLBP.
Medicare acupuncture benefits. The Centers for Medicare and Medicaid Services CMS currently recognizes just one acupuncture service for Medicare beneficiarieschronic lower back pain cLBP but does not recognize acupuncturists as Medicare providers. Acupuncture entails stimulating specific points on the body usually by inserting thin needles through the skin. Effective for services performed on or after January 21 2020 CMS will cover acupuncture for Medicare patients with chronic Lower Back Pain cLBP.
Medicare Part B Medical Insurance covers up to 12 acupuncture visits in 90 days for chronic low back pain. Up to 12 visits in 90 days are covered for Medicare beneficiaries under the following circumstance. Medicare covers an additional 8 sessions if you show improvement.
Original Medicare benefits are limited to a maximum of 20 sessions per year or less if the condition worsens. Medicare Advantage Plans and Acupuncture Medicare Advantage plans are meant to supplant Original Medicare Parts A and B and so theyre required to provide all the same benefits as Part A and Part B as a baseline with some room to expand services. Medicare plans have started covering acupuncture for lower back pain.
The Centers for Medicare Medicaid Services CMS has announced that Medicare will now cover acupuncture for patients with chronic low back pain in part because of the widespread abuse of opioids. Back and neck pain Migraines and tension headaches Lethargy Menstrual cramps and other symptoms Mental health and sleep disorders Nausea and morning sickness Neck tension Osteoarthritis Pain. On January 21 2020 the Centers for Medicare Medicaid Services CMS announced that they would cover acupuncture services to help treat chronic lower back pain.
Acupuncture is a treatment in which practitioners stimulate specific points on the body most often by inserting thin needles through the skin. Medicare will pay for sessions from doctors physician assistants nurse practitioners and other personnel as long as they have a masters or doctoral-level degree in acupuncture from an accredited school and have a license to practice acupuncture in a. Medicare part B may cover up to 20 acupuncture sessions per year for people with qualified medical conditions.
For the purpose of payment of Medicare benefits acupuncture is interpreted as including treatment by means other than the use of acupuncture needles where the same effect is achieved without puncture eg by application of ultrasound laser beams pressure or. As with other complex diseases CMS recognizes the importance of having treatment options which allow for an integrated approach that is tailored to the needs and preferences of Medicare patients. While acupuncturists can provide this service to Medicare beneficiaries they must do so as auxiliary personnel which requires.
Previously Medicare did not cover acupuncture to treat any condition but under the new rules Medicare beneficiaries could receive some of these treatments under Part B. Lasting 12 weeks or longer. This January CMS announced that Medicare would cover acupuncture for chronic low back pain.
Beneficiaries were responsible for 100 percent of all acupuncture costs. The Centers for Medicare Medicaid Services will cover acupuncture for chronic low back pain under section 1862 a 1 A of the Social Security Act httpswwwssagovOP_Homessacttitle181862htm. For the purpose of this decision cLBP is defined as.
Medicare beneficiaries who meet the qualifications will be able to receive 12 acupuncture sessions within a given 90-day period. Twenty acupuncture 20 visits are covered within a rolling 12-month period. Provided to subscribers enrolled with a Medicare Advantage or Platinum Blue Medicare Cost plan.
Until recently Original Medicare offered no coverage for acupuncture treatment. If your doctor decides your chronic low back pain isnt improving or is getting worse then Medicare wont cover your treatments. But there are many more additional areas where acupuncture has proven beneficial including the treatment of.
Learn about the exclusions and alternatives to acupuncture that. Below is the notice sent by CMS. When medically necessary Medicare Advantage members are eligible for the following acupuncture benefits.
Medicare Eligible Benefit The Centers for Medicare Medicaid CMS announced that acupuncture for low back pain is a covered benefit beginning in January 2020. Acupuncture was recently approved for treatment of lower back pain subject to the following conditions. CMS has approved new Medical Benefits for Medicare Members.
We explain whats covered and the requirements youll need to meet. Acupuncture for chronic low back pain will cover up to 12 visits in 90 days.
