Acupuncture Coverage

Acupuncture Coverage

July 23, 2020

Question:
My practice has decided to do acupuncture in our office. Does Medicare pay for acupuncture in 2020?

Answer:

Acupuncture CPT codes 97810-97814 are selected based on time and whether electrical stimulation is used. The only diagnosis currently that CMS covers is chronic low back pain. Medicare recently released Decision Memo for Acupuncture for Chronic Low Back Pain (CAG-00452N). Medicare will cover up to 12 visits in 90 days under these circumstances:

  • Chronic low back pain lasts 12 weeks or longer
  • Nonspecific, in that it has no identifiable systemic cause (i.e., not associated with metastatic, inflammatory, infectious, etc. disease)
  • Not associated with surgery
  • Not associated with pregnancy

In addition, an additional eight sessions will be covered for those patients demonstrating an improvement. No more than 20 acupuncture treatments may be administered annually. Treatment must be discontinued if the patient is not improving or is regressing.
Check with other payors for coverage guidance. Many payors do not cover acupuncture and keep in mind that if the patient has a diagnosis other than chronic lower back pain, Medicare does not cover the service.

*This response is based on the best information available as of 07/23/20.

 

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