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Medicare Will Now Cover Acupuncture for Chronic Lower Back Pain

Published Jan. 28, 2020

There may be some relief on the way for Medicare beneficiaries suffering from lower back pain. 

On January 21, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a finalized approval for coverage of acupuncture to treat lower back pain.

Acupuncture was previously not covered by Medicare under any circumstances. The recent decision to offer Medicare coverage for acupuncture only applies to treatment of chronic lower back pain. Chronic back pain is defined as pain that persists for three months or longer.

"Medicare beneficiaries will now have a new option at their disposal to help them deal with chronic low back pain, which is a common and sometimes debilitating condition." - Alex Azar, U.S. Secretary of Health and Human Services1

Medicare Advantage (Medicare Part C) plans may also now cover acupuncture to treat lower back pain, as Medicare Advantage plans offer at least the same benefits as Original Medicare (Medicare Part A and Part B). Most Medicare Advantage plans also offer prescription drug coverage.

The case for acupuncture in the fight against the opioid epidemic

Chronic lower back pain is most often treated with prescription painkillers. Providing Medicare coverage of acupuncture will give those with chronic lower back pain an additional treatment option, and it could also help in the fight against the U.S. opioid abuse crisis.  

In a press release addressing the proposal to cover acupuncture, U.S. Department of Health and Human Services (HHS) Secretary Alex Azar stated, “Defeating our country’s epidemic of opioid addiction requires identifying all possible ways to treat the very real problem of chronic pain, and this proposal would provide patients with new options while expanding our scientific understanding of alternative approaches to pain.”1

Acupuncture utilizes tiny needles to stimulate nerves in specific points on the body. The nerve sends a signal to the brain, which in turn releases endorphins and proteins into the body that mask pain and reduce inflammation.

The effectiveness of acupuncture to treat lower back pain remains up for debate. Everyone reacts differently to acupuncture treatments, and it’s difficult to conduct a controlled experiment using a placebo.

How does Medicare cover acupuncture?

In its press release announcing the new coverage decision, the CMS stated that Medicare will cover acupuncture for up to 12 sessions in 90 days. Patients with chronic lower back pain may qualify for an additional 8 sessions if they demonstrate improvement in their condition.

As mentioned above, Medicare Advantage plans (which are provided by private insurance companies) may also cover acupuncture for beneficiaries with lower back pain.

Medicare Advantage plans provide the same benefits as Original Medicare, and some plans may also cover things like routine dental and vision care, fitness classes and gym memberships, home-delivered meals, non-emergency transportation and more.

Learn more about Medicare Advantage plans and find a Medicare Advantage plan available near you that covers acupuncture. Call to speak with a licensed insurance agent today, or compare plans for free online with no obligation to enroll.

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