Does Medicare cover acupuncture for back pain?

Medicare pays for acupuncture for chronic low back pain. There are certain standards for this type of insurance, and the cost of acupuncture is not included in the medical insurance, and it is used to treat other diseases than chronic low back pain.

It’s important to know that Medicare may not cover everything your healthcare provider prescribes, especially alternative and complementary treatments. However, with the rise of the opioid epidemic, the Centers for Medicare and Medicaid Services (CMS) is looking for new ways to treat chronic pain syndromes. To that end, Medicare has added acupuncture for chronic low back pain as a covered benefit.

Acupuncture Medical Insurance

More recently, Medicare Part B has begun paying for acupuncture to treat certain conditions of chronic low back pain.

According to the Medicare.gov website, acupuncture is covered in the following guidelines:

  • For chronic low back pain, coverage is up to 12 acupuncture visits within 90 days.
  • If you show improvement, Medicare will cover 8 additional courses.
  • If your doctor determines that your chronic low back pain is not improving or getting worse, Medicare will not give you additional treatment.
  • The number of acupuncture treatments per year should not exceed 20.
  • Medicare does not cover acupuncture (including dry needling) for anything other than chronic low back pain.
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Please keep in mind that the details of these policies may change as evidence on beneficial effects and side effects is updated.

Alternatives to Opioids

The U.S. Centers for Disease Control and Prevention (CDC) estimated that as many as 20 percent of U.S. adults had chronic pain in 2016.

Chronic pain is thought to be responsible for an increase in opioid prescriptions over the years. While these drugs are appropriate in some situations, they can increase the risk of addiction and abuse in others. Between 1999 and 2018, nearly 450,000 Americans died from opioid overdoses. According to the National Institute on Drug Abuse, 128 people die every day from drug overdoses. Finding alternatives to opioids may be one way to stem the opioid epidemic.

For back pain, Medicare covers prescription drugs and, in some cases, epidural injections. Medicare may also cover physical therapy and chiropractic care (manual manipulation of the spine).

Acupuncture and Medical Conditions

Medicare is designed to cover medically necessary treatments, and acupuncture remains a controversial procedure. Acupuncture is an ancient Chinese practice in which small needles are inserted into certain areas of the skin to stimulate responses in certain areas of the body. The exact mechanism of how it works is unknown, although it is theoretically possible that neurohormonal pathways play a role.

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To date, acupuncture has been used to treat a variety of conditions, including allergic rhinitis, depression, fibromyalgia, headaches, hypertension, migraines, nausea, and pain syndromes ranging from low back pain to rheumatoid arthritis.

What is acupuncture and what are the benefits?

Acupuncture Research

While some studies have shown clinical benefits of acupuncture, others have shown that it is not necessarily more effective than other treatments, or even no treatment at all.

Sham acupuncture is sometimes used to evaluate the effects of acupuncture in research experiments. The researchers used this technique to simulate acupuncture by placing needles in areas of the skin that weren’t the correct acupuncture treatment site or that didn’t actually pierce the skin. Acupuncture needles are generally painless, so people who receive sham acupuncture can’t tell if they’re getting treatment. This helps reduce potential placebo effects in clinical studies.

For example, a 2018 meta-analysis​​​ pain journal A review of the results of 39 studies of nearly 21,000 patients with chronic pain (head, knee, lower back, neck and/or shoulder) concluded: “Acupuncture was superior to sham acupuncture and No need for acupuncture.”

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The American College of Physicians (ACP) recommends acupuncture for chronic back pain, National Institutes of Health (NIH) and Agency for Healthcare Research and Quality (AHRQ).

Health Insurance and Acupuncture

It’s also important for you to know that your health insurance coverage for health care services may not always be the same as Medicare coverage.

Your health insurance may cover acupuncture for conditions not covered by Medicare, or it may not cover acupuncture for chronic low back pain. Be sure to check your policy. If you decide to pay yourself, discuss the cost with your provider so you know how much and when you will need to pay.

VigorTip words

Living with chronic back pain isn’t always easy. It can impair your daily activities and reduce your overall quality of life. Managing chronic back pain often involves medical intervention, exercise, therapy, and lifestyle modifications. Acupuncture is one of the interventions that can help reduce chronic low back pain in some people, and in some cases, the cost is covered by Medicare.