Medicare for Acupuncture

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1. Medicare Policy for Acupuncture

Medicare Part B (Medical Insurance) covers only for chronic low back pain.  Medicare also doesn’t cover acupuncture for any condition other than chronic low back pain. Chronic low back pain is defined as: 1) Lasting 12 weeks or longer; 2) Not having a known cause (for example, not related to cancer that has spread, or an infectious or inflammatory disease); 3) Pain that isn’t associated with surgery or pregnancy

Medicare Part B covers up to 12 acupuncture visits in 90 days. Your copay is 20% of the Medicare-approved amount. Medicare can cover an additional 8 sessions if you show improvement in your initial 12 visit. You can get a maximum of 20 acupuncture treatments in a 12-month period. If you aren’t showing improvement in your initial 12 visits, Medicare won’t cover the 8 additional treatments.  

Medicare required you must get acupuncture from a doctor, or by another health care provider (like a nurse practitioner or physician assistant) who has both of these: 1) A masters or doctoral level degree in acupuncture or Oriental Medicine from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine, 2) A current, full, active, and unrestricted license to practice acupuncture in the state where you’re getting care.

However, Medicare declares that Medicare can’t directly pay Licensed Acupuncturists for their services. 

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2. Visit Our Clinic with Medicare

When you visit our clinic with Medicare, you will pay our senior price (25% discount) first. We will provider you CMS-1490S form (Patient’s Request for Medical Payment) and CMS-1500 Form (Itemized Bill). You  mail these forms to Medicare asking for reimbursement.  You must file the claim within one calendar year from the date of service. Once your claim is filed, it can take up to 60 days to process your request