Does Medicare cover acupuncture for pain?

Does Medicare cover acupuncture for pain? The quick answer is yes. Pain is the number one symptom that acupuncturists treat. It is a safe, easy, cost-effective alternative to opioids and other drugs. The Veterans Administration and the National Health Institute have, for several years, known its success, and now Medicare recognizes it as well.

Acupuncture treatment

First used in China more than 2,500 years ago, acupuncture as a medical system has become increasingly popular in the United States over the past decade. In the 1970s, only one school of acupuncture existed in the states. Today there are over 60, which include programs at MCPHS and Harvard.

As a complete medical system, acupuncturists are intensively trained, tested, and nationally certified to deliver safe, drug-free options for relieving many different types of pain. Low back and hip pain, neck and shoulder pain, headaches, fibromyalgia, musculoskeletal pain, tennis elbow, carpal tunnel syndrome, dental pain, and more. Research studies on Pub Med have also shown that it can help treat asthma, depression, digestive disorders, menopause symptoms like hot flashes, nausea caused by chemotherapy or anesthesia, and sleep disorders.

Exactly how or why acupuncture works isn’t fully understood, but based on the traditional Eastern theory, vital energy flows through pathways in the body called meridians or channels. When any of these pathways get blocked, pain and illness result. Acupuncture unblocks the pathways to restore health.

As Western bio-medicine practitioners research and try to explain how acupuncture works. Using functional MRI and blood tests in random control trials, we have learned that correct needle placement prescribed by traditional eastern practice stimulates the fascial tissue they lay outside of and between nerves and blood vessels. The needle’s microstimulation causes a release of endorphins, which are the body’s natural painkiller hormones. It’s also shown to increase blood circulation, decrease inflammation and stimulate the immune system.

What to expect

Acupuncturists are trained and hold a license in diagnosis and treatment. After a thorough intake of signs and symptoms, practitioners will develop a point prescription to rebalance the energy flow through the body -relieving symptoms, most often pain. By inserting thin needles through the skin, specific acupuncture points will be stimulated. The needles are solid, sterile and disposable (used only once), and as thin as a cat’s whisker.

The number of needles used for each treatment varies from one to a dozen, depending on the style and theory practiced and the condition being treated. They have typically inserted about one-quarter to 1-inch deep and are left in place for about 20 minutes. After placement, the needles may be twirled, stimulated with electricity or heat.

A brief, sharp sensation when the needle is inserted may be felt but passes quickly. Most patients report rarely feeling the insertion. However, once the needle is in place, you may feel a tingling sensation, heaviness, or warmth.

How many treatments you’ll need will depend on the severity of your condition. It is common to start with three appointments scheduled close together and then reassess. For patients with chronic pain, 6-12 treatments is very common. It’s also important to know that acupuncture can be used in conjunction with other conventional medical treatments or by itself.

Cost and coverage

The cost per treatment typically runs anywhere from $50 -$200 in the Northeast depending on what style of treatment you are receiving.

Today, an increasing number of private insurance plans, including some Medicare Advantage plans and employers’ policies, offer some acupuncture coverage. Many acupuncturists will bill your insurance directly; others will offer superbills for you to submit.

In January (2020), the Centers for Medicare and Medicaid Services announced that original Medicare will now cover up to 12 acupuncture sessions in 90 days for patients with chronic lower back pain. Eight additional sessions can be added if patients show improvement

I wish the reimbursement to as easy. To receive Medicare coverage for acupuncture, you must start with your physician. Currently, only a physician can bill Medicare for acupuncture therapy. Your physician will need to write a referral to a licensed acupuncturist, bill Medicare and then pay the acupuncturist. Currently, licensed acupuncturists cannot directly bill Medicare. What is exciting is that the national organization of professional acupuncturists is working to propose a bill into Congress that will change this. We will take our place as Medicare providers along with PT’s, Chiropractors, and Physicians.

To find an acupuncturist in your area, ask your doctor for a referral, or you can search online. Two good resources are the National Certification Commission for Acupuncture and Oriental Medicine (nccaom.org) to find a licensed acupuncturist and the American Academy of Medical Acupuncturists (medicalacupuncture.org), a directory of MDs and DOs who are certified to practice acupuncture.

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Amy O'Dell Wilson

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