Insurance COVERAGE

QUESTIONS TO ASK HEALTH INSURANCE COMPANIES FOR ACUPUNCTURE TREATMENT COVERAGE

• Does my plan cover acupuncture treatments?
• Are there deductibles, co-pay or co-insurance, how much are they?
• Do I need to get a pre-authorization? If so, how?
• Do covered acupuncture treatments be allowed to address …(state your condition and location of your issue)? Health insurance mainly covers acupuncture-treatments for pain.
• How many visits are allowed per calendar year?
• Am I allowed to seek acupuncture treatment from an acupuncturist who is not in the net-work and get reimbursed with proof of a treatment-and-payment receipt?
• Does my insurance plan reset at the beginning of a year? If not, what month?

Does Original Medicare or Medicare Advantage plan cover acupuncture?

Original Medicare  – does cover acupuncture treatments, but cannot be treated by a licensed acupuncturist who does not have medical status.

• The practitioner who inserts and treats a patient needs to have a medical status. Acupuncture is considered as an alternative medicine; an acupuncturist only has adjunct status, not medical status.
• Medicare plan allows 8 initial acupuncture treatments and can extend 4 more treatments when there’s progress with 90 days.
• Medicare only allows acupuncture treatment for chronic (lasted more than 60 days) lower back pain.
  When a regular licensed acupuncturist treats a patient with original Medicare coverage –
• The licensed acupuncturist needs to be supervised by a medical doctor
• The licensed acupuncturist has to have a degree from an accredited school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine (ACAOM)
• The acupuncturist needs to be currently fully active and licensed in the state where the practice location is
• The claims will need to be submitted from a medical doctor office

Medicare Advantage –As long as the Advantage plan covers acupuncture, can be treated by an acupuncturist.