No Easy Answer Whether Medicare Covers Acupuncture, Massage
Question: Does Medicare cover Acupuncture and Massage?
Answer: This is such an interesting question. Like all my answers that I give, the quick answer is “It Depends!” So let’s give the long answer to this question.
I should define Acupuncture. “Acupuncture is a technique where practitioners stimulate specific points on the body, most often by inserting thin needles through the skin.” (from www.medicare.gov)
Original Medicare (Medicare Part B) does cover Acupuncture in very particular circumstances. Original Medicare does not cover Massage at this time.
Under Medicare Part B benefits, Acupuncture is covered for the diagnosis/treatment of chronic low back pain only. This specific diagnosis is the only situation Original Medicare will cover a limited number of Acupuncture treatments, 12 acupuncture visits in 90 days. Medicare sometimes will cover an additional 8 sessions if you have shown improvement in your chronic back pain in the initial 12 visits. Original Medicare will cover no more than 20 acupuncture treatments in a given year.
The individual who performs the acupuncture must have a Masters or Doctoral level degree in acupuncture or Oriental Medicine from a school accredited by the Accreditation Commission on Acupuncture and Original Medicine, as well as a current, full, active and unrestricted license to practice acupuncture in the state where care is being provided.
If you decide to try acupuncture as a way to relieve your chronic low back pain be sure to check that the acupuncturist you are seeing has those credentials. You can find this information by asking the acupuncturist you are interested in seeing or using the www.medicare.gov
Individuals who have Original Medicare Part A & B, but have enrolled in a Medicare Advantage Plan (MA), your answer is different. Each MA plan must cover all the benefits that Original Medicare covers, but it can cover those treatments differently. It can also add to the benefits that Original Medicare includes.
MA Plans all cover Acupuncture differently than Original Medicare. They may cover more sessions/visits to the Acupuncturist. MA Plans may cover Acupuncture for more than just chronic low back pain. Each MA Plan has its own specific rules of coverage and their own co-pay structures. It could cost $20 or $35 per session or it could cover up to $250 per calendar year in Acupuncture visits.
It is important to read your specific MA Plan Evidence of Coverage to see how Acupuncture is covered and what your costs would be. You can also call the Customer Service number on the back of your card to ask them how your plan covers Acupuncture.
Many MA Plans also added the option of Massage to their benefits, but not all of them. Remember that MA Plans must cover everything that Medicare covers, but they can provide additional benefits if they choose.
This MA coverage of Massage is also very plan specific, so refer to your Evidence of Coverage documents or call the customer service phone number on your card to ask about Massage.
Some MA plans cover either Acupuncture or Massage up to $250 per year (not both, one or the other). Some MA Plans cover Acupuncture and Massage up to $250 each (both). They also could have a co-pay per visit of $20 or $35 per visit.
This Massage benefit is very new to the MA Plans, so be sure you understand the coverage rules and talk with your Massage provider to see how they understand the benefit. Are they in the network? Is a network necessary to use the coverage? Can you go to anyone and ask for reimbursement of the cost?
These are all important questions to ask your MA Plan Customer Service Department and your provider of Acupuncture and Massage.
In the situation where your provider does not participate in Medicare or your MA Plan, or your condition does not meet those standards required, you can still use Acupuncture and Massage to feel better, you just pay for the service yourself.
I hope you find a way to feel better soon.
Senior Life Matters is a community based program sponsored by Lutheran Jamestown. For questions and concerns or to reach Janell Sluga, GCMC, call us at 716-720-9797 or e-mail at SLM@lutheran-jamestown.org