Acupuncture

Question:

We are having trouble getting our acupuncture claims paid, can you advise if this is covered per Medicare and other payors? 

Answer:

In general, many payors do not cover acupuncture.  Therefore, it is the patient's responsibility to pay.  Check your payor policies regarding coverage criteria. 

Medicare recently released Decision Memo for Acupuncture for Chronic Low Back Pain (CAG-00452N).  https://www.cms.gov/files/document/mm13288-national-coverage-determination-3033-acupuncture-chronic-low-back-pain.pdf 

CMS will cover acupuncture for chronic low back pain – up to 12 visits in 90 days under the following circumstances: 

• For the purpose of this decision, chronic low back pain (cLBP) is defined as: Lasting 12 weeks or longer; nonspecific, in that it has no identifiable systemic cause (i.e., not associated with metastatic, inflammatory, infectious, etc. disease); not associated with surgery; and not associated with pregnancy. 

• An additional eight sessions will be covered for those patients demonstrating an improvement. No more than 20 acupuncture treatments may be administered annually. 

• Treatment must be discontinued if the patient is not improving or is regressing. 

Refer to Medicare’s coverage policy for the type of provider that may furnish the service and for other information. 

*This response is based on the best information available as of 6/6/24.