Does Medicare Cover Acupuncture?

Key Takeaways

• Medicare covers acupuncture only for chronic low back pain that meets specific criteria.
• Up to 12 sessions are covered in 90 days, with a possible 8 additional sessions if improvement is shown, for a maximum of 20 sessions per year.
• Only certain healthcare professionals with advanced acupuncture training and proper state licensure can provide covered services.
• Beneficiaries pay 20% coinsurance after meeting the Part B deductible; costs vary by provider and location.
• Medicare Advantage plans may offer broader acupuncture coverage, but benefits and costs differ by plan.

Medicare covers acupuncture for beneficiaries with chronic low back pain (cLBP), provided the pain has lasted for at least 12 weeks and is not linked to other underlying conditions such as surgery, pregnancy, or systemic diseases. This coverage is part of Medicare Part B and includes up to 12 sessions within a 90-day period. If the patient shows improvement, an additional 8 sessions may be covered, allowing for a maximum of 20 sessions per year. Acupuncture treatments are only covered when provided by a Medicare-approved acupuncturist with the necessary state licensure and advanced acupuncture training.

Understanding whether and how Medicare covers acupuncture is important for beneficiaries considering this treatment as an alternative to prescription medications or surgery. With coverage primarily focusing on chronic low back pain, beneficiaries should also explore whether their Medicare Advantage plan offers broader acupuncture benefits, as coverage can vary depending on the specific plan.

What Is Acupuncture?

Acupuncture is a traditional healing practice that has been used for thousands of years to restore balance within the body. It involves inserting fine needles into specific points on the skin, targeting pathways known as meridians. These meridians are believed to guide the body’s energy, or “qi,” and by stimulating them, acupuncture aims to promote natural healing and pain relief.

In modern healthcare, acupuncture is frequently used for managing conditions such as chronic low back pain, osteoarthritis, and stress-related ailments. Under Medicare, acupuncture is primarily covered for chronic low back pain (cLBP), offering an alternative to opioid medications and other invasive treatments. This expanded coverage reflects the growing recognition of acupuncture’s role in comprehensive pain management and holistic healthcare.

Medicare Coverage: The Basics

Medicare does provide coverage for acupuncture, but only under specific circumstances. The primary qualifying condition is chronic low back pain (cLBP) that meets strict criteria. Coverage began in January 2020, following a policy change by the Centers for Medicare & Medicaid Services (CMS) aimed at expanding non-opioid pain management options.

Before this change, acupuncture was excluded from Medicare benefits. The decision to include it was influenced by clinical evidence supporting acupuncture’s effectiveness for certain types of chronic pain and a growing emphasis on reducing opioid use among older adults.

When Does Medicare Cover Acupuncture?

Covered Condition: Chronic Low Back Pain

Medicare defines chronic low back pain as pain that:

• Persists for 12 weeks or longer
• Has no identifiable systemic cause (not related to cancer, infection, inflammatory disease, surgery, or pregnancy)
• Is not associated with recent trauma or surgical procedures

To qualify for coverage, the pain must be non-specific and ongoing, and other potential causes must be ruled out. The treatment must also be deemed medically necessary by a qualified provider.

Excluded Conditions

Medicare does not cover acupuncture for any condition other than chronic low back pain. This means treatments for arthritis, migraines, neuropathy, fibromyalgia, or other types of pain are not eligible for reimbursement through Original Medicare.

The limitation is due to the current evidence base and policy decisions prioritizing non-opioid pain management for chronic low back pain. As research evolves, coverage rules may be updated, but for now, the scope remains narrow.

Medicare Part B: Acupuncture Coverage Details

Medicare Part B is the component of Original Medicare that covers medically necessary outpatient services, including doctor visits, diagnostic tests, and certain therapies provided outside of hospital settings. It is designed to help beneficiaries access non-hospital care that supports diagnosis, treatment, and management of chronic conditions. Acupuncture for chronic low back pain falls under Part B coverage because it is considered an outpatient medical treatment aimed at managing persistent pain.

Under Medicare Part B, acupuncture is covered specifically for chronic low back pain that has lasted at least 12 weeks and meets strict criteria. Coverage includes up to 12 acupuncture sessions within a 90-day period. If measurable improvement is documented by the healthcare provider, Medicare allows up to 8 additional sessions, bringing the annual maximum to 20 sessions. If no improvement is observed, Medicare will not cover further treatments, and the beneficiary will be responsible for all subsequent costs.

To qualify for Medicare reimbursement, acupuncture must be provided by a healthcare professional who:

• Holds a master’s or doctoral degree in acupuncture or Oriental Medicine from a school accredited by the Accreditation Commission on Acupuncture and Herbal Medicine (ACAHM).
• Has a current, full, active, and unrestricted license to practice acupuncture in the state where the treatment is given.
• Is a physician, nurse practitioner, or physician assistant; most licensed acupuncturists without these medical credentials are not eligible to bill Medicare directly.

Providers are required to maintain detailed documentation, including the diagnosis, treatment plan, and evidence of patient improvement, to support ongoing coverage. While a formal referral is not always mandatory, thorough medical records are essential to justify additional acupuncture sessions under Medicare Part B.

Beneficiaries should also be aware that after meeting the annual Part B deductible ($257 in 2025), they are responsible for 20% coinsurance of the Medicare-approved amount for each session. Choosing providers who accept Medicare assignment can help minimize out-of-pocket expenses.

How Much Does Acupuncture Cost With Medicare?

Under Original Medicare, costs are shared between the program and the beneficiary:

• After meeting the annual Part B deductible ($257 in 2025), Medicare covers 80% of the approved amount for each session.
• The beneficiary pays the remaining 20% coinsurance, plus any additional charges if the provider does not accept Medicare assignment.
• Session costs can vary widely, from $15 to $400 per visit, depending on provider and location.

Medicare Advantage (Part C) and Acupuncture

Medicare Advantage, also known as Part C, is a type of Medicare plan offered by private insurance companies that combines the benefits of Original Medicare Parts A and B. These plans often include additional services and benefits beyond what Original Medicare covers, sometimes offering expanded acupuncture coverage.

While Medicare Advantage plans must cover at least the same acupuncture benefits as Original Medicare for chronic low back pain, many go further by covering more sessions or acupuncture for other conditions such as migraines or osteoarthritis.

Coverage details, costs, provider networks, and prior authorization requirements vary by plan, so it is important to review your plan’s Evidence of Coverage or contact your plan administrator to understand the specific acupuncture benefits available to you.

Key Differences:

• Coverage, costs, and provider networks vary by plan. Some may include acupuncture for conditions beyond cLBP, such as migraines or osteoarthritis.
• Out-of-pocket costs (premiums, deductibles, copayments) depend on the specific plan and may differ from Original Medicare.
• Always confirm with your plan administrator to understand what is covered, which providers are in-network, and any prior authorization requirements.

Checking your plan’s Evidence of Coverage or contacting customer service can clarify eligibility for expanded acupuncture benefits.

How to Get Acupuncture Paid for by Medicare

• Confirm Eligibility:

Ensure your diagnosis meets Medicare’s definition of chronic low back pain and that no excluded causes are present.

• Find a Qualified Provider:

Locate a healthcare professional who meets Medicare’s licensure and training requirements and is authorized to bill Medicare for acupuncture.

• Verify Coverage:

Contact Medicare or your Medicare Advantage plan to confirm coverage details, session limits, and any documentation requirements.

• Track Progress:

Providers must document improvement to justify additional sessions beyond the initial 12. Keep records of your pain levels and functional changes.

• Control Costs:

Use providers who accept Medicare assignment to minimize out-of-pocket expenses. Consider Medigap or supplemental insurance for additional coverage.

What Parts of Medicare Pay for Acupuncture?

• Part B: Covers outpatient acupuncture services for chronic low back pain when provided by eligible professionals.
• Medicare Advantage (Part C): May expand coverage, including more conditions or sessions, depending on the plan.
• Parts A and D: Do not cover acupuncture. Part A is for inpatient care; Part D is for prescription drugs.

What to Do If You Need Acupuncture for Other Conditions

If you seek acupuncture for conditions not covered by Original Medicare, consider these options:

• Medicare Advantage: Some plans may include broader acupuncture benefits. Review plan details or consult a plan representative to explore options.
• Supplemental Insurance: Medigap policies do not expand acupuncture coverage but may help with coinsurance or deductibles.
• Out-of-Pocket Payment: If coverage is denied, discuss pricing with your provider, request written estimates, and ask about payment plans or discounts.

Planning ahead can help manage costs and avoid surprises if you pursue acupuncture for non-covered conditions.

Acupuncture vs. Other Covered Pain Treatments

Medicare supports a range of non-opioid pain management strategies for chronic conditions:

• Chiropractic Care: Covered only for manual manipulation of the spine to correct subluxation, not for acupuncture or other pain types.
• Physical Therapy: Often covered for rehabilitation and pain management, with broader indications than acupuncture.
• Occupational Therapy: Addresses functional limitations from chronic pain or injury.

Acupuncture may be preferable for those seeking holistic or integrative approaches, while others may benefit from combining therapies. At ACA Acupuncture and Wellness, we take a personalized approach to pain management. Our team of skilled practitioners works with you to explore various options and ensure that your pain management plan is tailored to meet your specific needs. Discussing your options with our experienced practitioners will help you find the best combination of therapies to restore balance and improve overall wellness.

Sources:
Centers for Medicare & Medicaid Services. (2020, January 21). CMS finalizes decision to cover acupuncture for chronic low back pain for Medicare beneficiaries.

Centers for Medicare & Medicaid Services. (n.d.). Acupuncture coverage. Medicare.gov.