Signed in as:
filler@godaddy.com
Insurance Information
Acupuncture & Privatized Insurance
Being a small medical office, we focus our time on great treatment. This means that our medical providers do not directly bill to insurance providers because we do not have the resources to keep up with billing administration.
Most privatized insurance plans provide patient portals to submit their own claims. Many insurance providers now have benefits for acupuncture. In order to find out if you have acupuncture benefits attached to your insurance plan, you will have to contact your insurance provider or read your explanation of benefits (EOB) for your specific insurance plan. Benefits will vary greatly from plan to plan, so make sure you know the requirements and limits of your plan.
We are labeled as "out-of-network providers". This means that you have the ability to find reimbursement for our services is your have "out-of-network benefits". These benefits, which include all types of out-of-network providers, will often have a deductible or set amount of treatments before any reimbursement kicks in. So, please check your specific explanation of benefits.
You will want to ask your insurance provider:
- Do I have acupuncture out of network benefits?
- How many visits are allowed per calendar year?
- What conditions are covered?
- Are there any limitations to the treatments?
- Are there any limitations to the amount of visits per calendar year?
- Are there any limitations as to who can provide the acupuncture services?
- If the acupuncturist is not an MD, will he/she need an overseeing provider?
If you do have acupuncture benefits, we are able to furnish you with a "coded superbill", which is a receipt that has insurance coding for self submission. Just ask us at the end of your treatment and we will be happy to email one over to you.
Is acupuncture covered through Medicare?
Inn general, Medicare does not cover acupuncture well. There are some privatized Medicare policies that cover love back pain, but general Medicare like A and B do not cover acupuncture by a licensed acupuncturist.
Some original Medicare (type A or B) programs need for your acupuncture provider to have a MD, NP or PA to sign on with the treatment to become an "overseeing provider". Some do not accept it at all. In the U.S., licensed acupuncturists cannot bill directly to original Medicare A or B programs.
If you have a Medicare Advantage (type C) program, then acupuncturists may not need an "overseeing provider" like a MD, DO, NP or PA. Although, this will vary from plan to plan and patients need to find out what their options are before considering acupuncture when insurance is a necessary option.
What conditions are covered for Medicare patients?
Acupuncture inclusion to Medicare has parameters and is currently limited to chronic lower back pain (cLBP). The Centers for Medicare & Medicaid Services (CMS) will cover acupuncture for chronic low back pain under section 1862(a)(1)(A) of the Social Security Act. Up to 12 visits in 90 days are covered for Medicare beneficiaries under the following circumstances:
For this Medicare decision, chronic low back pain is defined as pain:
- Lasting 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; and
- Not associated with pregnancy.
For those patients demonstrating an improvement, an additional eight visits will be allowed, but no more than 20 acupuncture treatments may be administered annually. Treatment must be discontinued if the patient is not improving or is regressing.
What do I submit with the claim?
What do I submit with the claim?
What do I submit with the claim?
Follow the instructions on the form for the type of claim you're filing. Generally, you’ll need to submit:
- The completed claim form (Patient Request for Medical Payment form (CMS-1490S). This is downloadable from the above link as well.
- The itemized bill from your doctor, supplier, or other health care provider
- A letter explaining why you’re submitting the claim (like if your provider or supplier isn’t able to file the claim, refuses to file the claim, or isn’t enrolled in Medicare)
- Any supporting documents related to your claim (like notes from your doctor)
Who can help me file a claim?
What do I submit with the claim?
What do I submit with the claim?
- State Health Insurance Assistance Program (SHIP): Visit shiphelp.org to get the phone number for your local SHIP and get free, personalized health insurance counseling. SHIPs are state programs that get money from the federal government to give free local health insurance counseling to people with Medicare.
- Medicare: Talk or live chat with a real person, 24 hours a day, 7 days week (except some federal holidays) by calling 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
- Representative: If you have a family member or friend helping you with a complaint, you can appoint them as a representative. Download and share your claims with trusted sources.
What are the timeframes for filing a claim?
What are the timeframes for filing a claim?
What are the timeframes for filing a claim?
State Health Insurance Assistance Program (SHIP): Visit shiphelp.org to get the Medicare claims must be filed no later than 12 months (or 1 full calendar year) after the date when the services were provided unless an exception applies. If a claim isn't filed within this time, Medicare won't pay its share. How can I check the status of a claim once I've filed it? Example: If you see your doctor on March 22, 2019, your doctor must have filed the Medicare claim for that visit by March 22, 2020. Check the "Medicare Summary Notice" (MSN) you get in the mail, log into your secure Medicare account, or check your plan's claims statements to make sure claims are being filed in a timely way.
Where do I send the claim?
What are the timeframes for filing a claim?
What are the timeframes for filing a claim?
If you have Original Medicare, you'll need to mail your claim form, itemized bill and supporting documents to the address for your state, which is listed on the Medicare Administrative Contractor Address Table within the claim form.
Medicare Patient Reimbursement CMS-1490S (pdf)
Download