Does Medicare Cover Acupuncture?

Acupuncture is a form of treatment that places needles on your back or even other parts of your body. It is a common treatment for back pain and arthritis, as well as headaches and migraines.

So a common question many people have is, “does Medicare cover acupuncture?” In this article, we answer that question in clear, plain English. You will also find the average costs of acupuncture and other helpful info.

Does Medicare Cover Acupuncture?

The short answer is yes; Medicare will cover the cost of acupuncture. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your acupuncture. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for acupuncture. Coverage for acupuncture treatment is provided by Medicare Part B.

Medicare Part B covers 12 acupuncture sessions within 90 days. However, Medicare Part B may cover up to 20 sessions of acupuncture treatment in a year. It may cover those additional 8 sessions if you are showing improvement during your acupuncture treatment.

However, you must meet some conditions for Medicare Part B to provide coverage for your acupuncture treatment. These conditions consist of the following:

If you are diagnosed with lower back pain and you have experienced it for 12 weeks or longer already
Your back pain is not due to metastatic, inflammatory, or infectious disease, or it does not have an identified systemic cause
Surgery or pregnancy did not cause your back pain
If your healthcare provider is qualified to perform acupuncture treatment. Your healthcare provider is considered qualified if he/she has:
- A master or doctoral-level degree in acupuncture or Oriental Medicine, and he/she got the degree in a school recognized by the Accreditation Commission on Acupuncture and Oriental Medicine (ACAOM)
- A current, full, active, and unrestricted license that allows him/her to practice acupuncture in the state where he/she will perform the acupuncture treatment

Medicare Part B only provides coverage for acupuncture treatment for chronic lower back pain. Once approved by Medicare Part B, they will cover 80 percent of the costs of your acupuncture treatment. You will pay for the remaining 20 percent.

Part C Coverage for Acupuncture

Medicare Advantage plans (Medicare Part C) also provide coverage for acupuncture. They cover everything Original Medicare covers but usually also provide some additional benefits. However, exactly what Part C plans cover and what your out-of-pocket costs are will vary depending on the specifics of your plan.

Because Medicare Part C plans must provide coverage for everything Original Medicare covers, all Part C plans provide coverage for acupuncture treatment for chronic lower back pain. However, some Medicare Part C plans may offer additional coverage for acupuncture treatment to treat other conditions.

How Much Does Acupuncture Cost?

The first acupuncture session usually costs around $120 to $300. Later sessions average between $75 and $300.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.