The Medicare Dilemma

I with this cartoon was merely satirical, but unfortunately it's reality.

Frequently I receive inquiries about acupuncture and Medicare—especially now that many Medicare patients have heard they have coverage for lower back pain. Given how common low back pain is among seniors, the possibility of receiving regular acupuncture can feel incredibly encouraging.

But then the truth comes out.

Yes, Medicare covers acupuncture for lower back pain—but licensed acupuncturists are not recognized Medicare providers. That means a fully trained, state-licensed acupuncturist cannot bill Medicare. And if a patient pays out of pocket and submits their receipt for reimbursement, that claim will still be denied.

Quite a dilemma—though there is a partial workaround.

Technically, Medicare patients can receive covered acupuncture if they see a Medicare-enrolled medical doctor who performs acupuncture. In New Jersey, physicians can perform acupuncture with just 300 hours of additional training. If that physician accepts Medicare, the acupuncture sessions can be covered. Unfortunately, very few doctors pursue the extra training, and most prefer referring patients to licensed acupuncturists. Personally, I don’t know a single physician who offers acupuncture.

A somewhat more accessible option is visiting a licensed acupuncturist who works under the supervision of a medical doctor. A few group practices are organized this way, and treatments for lower back pain may be covered—but this model is still uncommon.

If you’re wondering why Medicare covers the procedure but not the person who specializes in delivering it, the answer lies in legislation. Policy changes must first approve the service before they can recognize the provider. It’s a classic cart-before-the-horse situation, but that’s how federal law progresses.

Fortunately, there is movement forward. For several years, acupuncturists have introduced legislation in Congress to make licensed acupuncturists Medicare-recognized providers. If and when that bill becomes law, Medicare patients will finally be able to see licensed acupuncturists for back pain and have their treatments covered. It’s unclear how long passage will take, but the bill gains more sponsors every year—a strong sign that support is building.