Acupuncture is a treatment that involves inserting thin needles through a person's skin at specific points on the body. This type of service is normally performed in the sphere of pain management.
Covered or non-covered, acupuncture is a great tool for helping your patients cope with pain and other negative aspects.
Medicare Coverage of Acupuncture
In 2020, Medicare started to cover acupuncture as a treatment for lower back pain. Now, Medicare covers up to 12 acupuncture treatment sessions for those patients with chronic lower back pain, performed within three months. Coverage for further sessions is available for members whose symptoms improve after the first 12 sessions. However, more than 20 acupuncture treatments annually will not be covered.
Chronic low back pain is defined as follows:
- Lasting twelve weeks or longer;
- Nonspecific. Has no identifiable systemic cause (e.g., not associated with metastatic, inflammatory, infectious disease, etc.);
- Not associated with surgery and pregnancy.
For Medicare to cover acupuncture, the professional administering the treatment must comply with state requirements and can be:
- a Physician
- a Physician Assistant (PA)
- a Nurse Practitioner (NP)
- a Clinical Nurse Specialist (CNS)
- Auxiliary personnel
PA, NP/CNS (as identified in 1861(aa)(5)), and auxiliary personnel may provide acupuncture treatment if they meet state requirements and have:
- Masters or doctoral-level degree in acupuncture or Oriental Medicine from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine (ACAOM); and
- current, full, active, and unrestricted license to practice acupuncture in a State, Territory, or Commonwealth (i.e., Puerto Rico) of the United States, or District of Columbia
Important! Auxiliary personnel who provide acupuncture must be under the appropriate level of supervision of a physician, PA, or NP/CNS.
Fees are based on the locality. Below are the approximate rates. Medicare Part B cost-sharing will be applied.
|
Procedure CPT code |
Description |
Fee schedule |
Effective Date |
|
97810 |
Acupuncture, one or more needles; without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient |
44.51 |
01/21/2020 |
|
97811 |
Acupuncture, one or more needles; without electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of the needle(s) (List separately in addition to code for primary procedure) |
34.17 |
01/21/2020 |
|
97813 |
Acupuncture, one or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient |
49.46 |
01/21/2020 |
|
97814 |
Acupuncture, one or more needles; with electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of the needle(s) (List separately in addition to code for primary procedure) |
40.87 |
01/21/2020 |
Medicare Advantage plans must provide the same level of coverage as traditional Medicare under the same conditions.
New York State Requirements
Currently, acupuncturists may not bill Medicare services, as they are not recognized by CMS.
It is possible, however, for acupuncturists to perform the treatment as auxiliary personnel "incident to" a physician's service in certain settings.
Before hiring an acupuncturist, check your state requirements, as for New York State, licensed physicians who use acupuncture in their professional practice must be certified. That means that the MD provider must have the Acupuncture certification in order to hire and supervise an Acupuncturist in New York State. http://www.op.nysed.gov/acupuncert.htm
Also, acupuncture does not fall within the nursing scope of practice in NYS (including RN, CNS, NP, or LPN). If an NP wishes to practice acupuncture, they would need to meet the requirements for licensure in that profession, which may be found at this link: http://www.op.nysed.gov/prof/acu.
Source:
https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=295
