It’s important for you to know that Medicare might not cover everything prescribed by your healthcare providers, especially alternative and complementary treatments. With the rise of the opioid epidemic, however, the Centers for Medicare and Medicaid Services (CMS) is looking to find new ways to treat chronic pain syndromes. To that end, Medicare has added acupuncture for chronic low back pain treatment as a covered benefit.
Medicare Coverage for Acupuncture
Recently, Medicare part B has begun covering the cost of acupuncture for the treatment of chronic low back pain in some circumstances.
According to the Medicare.gov website, acupuncture is covered under the following guidelines:
Coverage can be for up to 12 acupuncture visits in 90 days for chronic low back pain. Medicare covers an additional 8 sessions if you show improvement. If your doctor decides your chronic low back pain isn’t improving or is getting worse, then Medicare won’t cover your additional treatments. No more than 20 acupuncture treatments can be given yearly. Medicare doesn’t cover acupuncture (including dry needling) for any condition other than chronic low back pain.
Keep in mind that the specifics of these policies may change as evidence regarding beneficial effects and side effects are constantly being updated with new research.
Alternatives to Opioid Medications
The Centers for Disease Control and Prevention (CDC) estimated that as many as 20% of American adults suffered from chronic pain in 2016.
Chronic pain is believed to have contributed to an increase in opioid drug prescriptions over the years. While these medications are appropriate in some cases, they increase the risk of addiction and abuse in others. Between 1999 and 2018, almost 450,000 Americans died from an opioid overdose. According to the National Institute on Drug Abuse, 128 people die from an overdose every day. Finding alternatives to opioid medications may be one of the ways to stem the rising opioid epidemic.
When it comes to back pain, Medicare covers prescription medication 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 aims to cover treatments that are medically necessary, and acupuncture remains a controversial procedure. Acupuncture is an ancient Chinese practice where small needles are inserted into certain areas in the skin to stimulate responses in certain areas of the body. The exact mechanism for how it works is unknown, though it is theorized that neurohormonal pathways may play a part.
To date, acupuncture has been used to treat a number of conditions including allergic rhinitis, depression, fibromyalgia, headache, hypertension, migraine headaches, nausea, and numerous pain syndromes ranging from low back pain to rheumatoid arthritis.
The Research on Acupuncture
While some studies show clinical benefits with 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. Researchers use this technique to simulate acupuncture by placing needles in areas of skin that are not the correct acupuncture treatment points or without actually puncturing the skin. Acupuncture needles are generally painless, so someone treated with sham acupuncture will not be able to tell if they received the treatment or not. This helps to reduce the potential placebo effect in clinical studies.
For example, a 2018 meta-analysis in The Journal of Pain reviewed the results of 39 studies across nearly 21,000 patients for people with chronic pain (head, knee, low back, neck, and/or shoulder), concluding that “acupuncture was superior to sham acupuncture as well as no acupuncture for each pain condition.”
Health Insurance and Acupuncture
It’s also important for you to know that the cost of health care services covered by your health insurance might not always be the same as Medicare coverage.
Your health insurance might cover acupuncture for conditions that aren’t covered by Medicare, or it might not cover acupuncture for the treatment of chronic low back pain. Be sure to check your policy. And if you decide to pay for it yourself, discuss the cost with your provider so you can understand how much and when you will be expected to pay.
A Word from Verywell
Living with chronic back pain is not always easy. It can impair your day-to-day activities and can decrease your overall quality of life. Managing chronic back pain usually involves medical interventions, exercise, therapy, and lifestyle adjustments. Acupuncture is one of the interventions that can be helpful for reducing chronic low back pain for some people, and the cost is covered by Medicare in some circumstances.
