Does Medicare Cover Acupuncture?
Is acupuncture part of your pain relief routine, or something you’ve been meaning to try?
This ancient practice has been used for thousands of years in traditional Chinese medicine to help alleviate pain, improve circulation, and restore balance in the body.
Today, more seniors are turning to acupuncture and oriental medicine as alternative therapies for chronic pain, arthritis, and other age-related health concerns. In fact, Time Magazine has claimed acupuncture has gone “mainstream in medicine” in recent years.
As a result of this practice’s growing popularity, many seniors are asking, “Does Medicare cover acupuncture? If so, when?”
Let’s break down what Medicare will and won’t pay for, what qualifies under current guidelines, and what your options are if your condition falls outside those rules.
Table of Content
1. What Medicare Covers (and What It Doesn’t)
2. Limits and Restrictions on Medicare Acupuncture Coverage
3. Acupuncture Coverage Under Medicare Advantage Plans
4. What If Acupuncture Isn’t Covered?
5. Common Questions About Acupuncture and Medicare
6. Final Thoughts: Is Acupuncture Worth It If You’re on Medicare?
7. Need Help Understanding Your Medicare Options?
What Medicare Covers (and What It Doesn’t)
Medicare Part B covers certain medically necessary services, and that includes acupuncture treatment, but only in a very specific situation. Here’s what you need to know:
Medicare Will Cover Acupuncture, But Only for Chronic Low Back Pain
According to the Centers for Medicare & Medicaid Services (CMS), Original Medicare (Part B) covers acupuncture treatment for chronic low back pain only.
To qualify:
- The pain must last 12 weeks or longer
- It must not be associated with surgery, pregnancy, or any known underlying condition (such as cancer or infectious disease)
- The acupuncture must be administered by a qualified healthcare provider, such as a physician, nurse practitioner, or physician assistant with a license to practice acupuncture or supervision over someone who does.
CMS defines chronic low back pain as persistent or recurrent pain in the lower back lasting 12 weeks or longer, without a known cause. Therefore, Medicare does not cover acupuncture for other types of pain, such as:
- Arthritis
- Neck pain
- Migraines or headaches
- Fibromyalgia
- Post-surgical pain
In summary, while acupuncture may offer relief for a wide range of conditions, Medicare coverage is strictly limited to chronic low back pain that meets very specific criteria. Anything outside of that must be paid for out of pocket.
Limits and Restrictions on Medicare Acupuncture Coverage
Even if you qualify, Medicare coverage for acupuncture treatment comes with several restrictions:
- Medicare Part B will pay for up to 12 visits in 90 days
- If you show improvement (i.e., pain decreases or function improves), Medicare may cover 8 additional sessions, for a maximum of 20 visits per year
- No further coverage is available beyond those 20 sessions annually
Also, the acupuncture must be provided by or supervised by a doctor or healthcare provider who has a doctoral-level degree in acupuncture or oriental medicine from a school accredited by the Accreditation Commission for Acupuncture and Herbal Medicine.
If the provider doesn’t meet Medicare requirements or is not contracted with Medicare as an in-network provider, the service may not be covered, even if the treatment was appropriate.
Check Your Acupuncture Coverage Options Today
Acupuncture Coverage Under Medicare Advantage Plans
Do Medicare Advantage plans cover acupuncture more broadly? Sometimes.
Medicare Advantage (Part C) plans are offered by private insurers approved by Medicare. These plans are required to offer at least the same benefits as Original Medicare but may also provide extra benefits, including more generous acupuncture coverage.
Depending on the insurer, some Medicare Advantage plans may:
- Offer more than 20 sessions per year
- Cover acupuncture for other forms of chronic pain beyond just chronic low back pain
- Include related services such as massage therapy or complementary and integrative health options
However, not all types of Medicare Advantage plans cover acupuncture this way, and benefits can vary widely depending on the insurer, plan, and location.
If you live in Nevada, especially around Sparks or Reno, your local Medicare Advantage plan may offer additional acupuncture or oriental medicine benefits. However, you’ll need to check your specific policy.
See If Your Plan Includes Acupuncture Sessions
What If Acupuncture Isn’t Covered?
If you’re considering acupuncture treatment for something other than chronic low back pain, Medicare likely won’t cover it. That means you may need to pay out of pocket.
What Does It Cost?
The cost of acupuncture varies depending on the provider and region. In the Sparks and Reno areas, you may pay between $75 and $125 per session, sometimes more. Some clinics offer discounted packages for multiple visits.
Tips for Managing the Cost:
- Ask if your provider offers sliding scale fees
- Look for community clinics or schools of acupuncture and oriental medicine, where services may be lower-cost
- Consider other Medicare-covered treatments for pain management, such as physical therapy, chiropractic care, or medications
You may also be able to use a Health Savings Account (HSA) or Flexible Spending Account (FSA) to help pay for acupuncture, depending on your insurance plan and tax status.
Medicare doesn’t administer HSAs or FSAs, but if you still have one from a prior job or retiree account, it may help offset your costs.
Common Questions About Acupuncture and Medicare
Will Medicare cover acupuncture for arthritis or migraines?
No. Original Medicare does not cover acupuncture for arthritis, migraines, fibromyalgia, or other conditions. Only chronic low back pain qualifies.
Can I use my HSA or FSA for acupuncture treatment?
In many cases, yes. Acupuncture is often considered an eligible expense under medical insurance when it’s used to alleviate pain or treat a documented condition. Talk with your tax advisor or plan administrator to confirm.
What documentation do I need?
To qualify for Medicare coverage, your healthcare provider must document the following:
- Diagnosis of chronic low back pain
- Medical necessity for acupuncture
- Progress notes showing improvement if more than 12 sessions are requested
This documentation helps the Centers for Medicare & Medicaid Services determine whether continued treatment is justified. Without proper records, Medicare may deny coverage, even if the condition technically qualifies.
Contact Us For Medicare Acupuncture Eligibility
Final Thoughts: Is Acupuncture Worth It If You’re on Medicare?
Acupuncture is a respected alternative medicine therapy with a long history in traditional Chinese medicine. Many seniors report meaningful pain relief, especially for chronic conditions.
However, Medicare’s acupuncture coverage is currently limited.
If you suffer from chronic low back pain, Medicare Part B may cover up to 20 acupuncture sessions per year. For other conditions, coverage is unlikely unless you have a Medicare Advantage plan that provides additional benefits.
Before starting treatment, it’s wise to:
- Confirm whether your provider is a Medicare provider qualified to bill for acupuncture
- Ask your Medicare Advantage plan whether expanded benefits are offered
- Weigh the potential benefits against the out-of-pocket costs
Acupuncture can be a great option for managing pain, but before you book a session, it’s worth knowing what Medicare actually covers (and what it doesn’t). Taking a little time to understand your benefits now can save you from surprise bills later.
Need Help Understanding Your Medicare Options?
Curious whether your Medicare Advantage plan covers acupuncture? Not sure if your current coverage fits your health needs or budget?
Contact Senior Insurance Agency today. Our licensed health insurance brokers in Reno are here to help you compare plans, understand your benefits, and explore options that include alternative therapies like acupuncture, without pressure or confusion.
About the Author: Aliana Rushing
I have worked at Senior Insurance Agency since 2016, and became a licensed insurance agent in 2018. I specialize in senior products (Medicare Supplement, Medicare Advantage Part C, and Part D). I take much pride in my work and in providing my clients with exceptional service. My approach to Medicare…