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Insurance info
Acupuncture & Privatized Insurance
Being a small medical office, we focus our energy on great treatments. This means that our medical providers do not directly bill to insurance providers because we do not want them dictating how we treat nor do we 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 policy. Benefits will vary greatly from, so make sure you know the requirements and limits of your benefits.
We are "out-of-network, direct entry medical providers". This means that you have the ability to find reimbursement for our services if your have "out-of-network benefits" for acupuncture. 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 "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?
In general, Medicare does not cover acupuncture well if a licensed acupuncturist is performing the therapy. If an M.D., who is a licensed acupuncturist performs the therapy, insurance benefits are more likely to be billable.
In the U.S., licensed acupuncturists cannot bill directly to original Medicare A or B programs. 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. 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 will 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.
Who can help me file a 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.