MEDICARE & ACUPUNCTURE
Regarding Medicare policy for coverage of acupuncture for chronic low back pain:
On January 21, 2020 a decision memorandum was released by Medicare that said yes, they will cover acupuncture for chronic low back pain. Further it specified they will cover 12 initial visits and if progress is shown and documented in those 12 visits, they will cover 8 additional visits with a maximum of 20 visits in a 12 month period. They even take steps to ensure public safety; they are specifically saying that acupuncture should be provided by a licensed acupuncturist, or medical doctors who have special training in medical acupuncture in what comes out to several hundred more hours of additional training. This is great in ensuring there are quality providers who are properly licensed providing these services under Medicare. The problem is that licensed acupuncturists are not included as providers under the current legislation.
So this means we actually need an act of Congress, signed by the President, to make this change. There have been a number of initiatives over the last few years to try to do this, most recently Representative Judy Chu out of Washington State had a bill, HR 1183 Acupuncture for Our Seniors and Heroes. It did not make it, but this bill is a good example of what is needed. We will need your Congressional Representatives and Senators, to get on board to support a bipartisan bill that will actually expand Medicare coverage so licensed acupuncturists are providers and can actually provide the service that you want.
Until then, unfortunately, the only way that acupuncture can be covered under Medicare is if it’s done through a doctor’s office or a nurse practitioner’s office who’s providing supervision and billing for the licensed acupuncturist. A number of acupuncturists aren’t going to be able to find a medical office willing to do this billing. The policy is so new, that unlike most other Medicare procedures that have tons of documentation providing detailed guidance for providers and billers we don’t have that yet for this coverage and that still needs to be developed. Nobody wants to find out that they’ve committed Medicare fraud because whether you meant to do it or not, it still carries a pretty hefty penalty that can include loss of licensure and a felony conviction – so providers are going to want to be careful about how they implement this.
When they implement this, it’s going to take some time so when you call don’t be disappointed if we can’t take Medicare patients at that time. There may be a provision to get reimbursement, but again, because we’re not covered providers, even though the procedure itself is covered, it doesn’t currently qualify until we get that change, so this will take a grassroots initiative; a lot of people reaching out, letting their senators and congressmen know you want to see a bill similar to Judy Chu’s HR1183.
This bill has solid language, it doesn’t have a lot of other pork in it, so it’s a good example of what the legislation should look like and it’s got the appropriate level for acupuncturists to be included in Medicare that’s on par with what our licensure and training is. So please, take the time, make some calls, let your friends know we would love to be able to make the service available, but right now it looks like a little bit of a bait and switch – yes we cover it – but the broadest number of providers who actually provide the service are not covered.
So yes, Medicare is covering acupuncture; no, it’s not going to be easy to find a provider who can actually do that until we get some changes.
For further information regarding Medicare Coverage:
Judy Chu’s bill HR1183 which is a good example of the kind of legislation that will be needed for Medicare to be covered by acupuncturists: