INSURANCE

Laura Mutsko Agent and CSA

Q: I have pain in my lower back, but I do not want to start taking pain pills. I would like to try acupuncture. Will Medicare cover my treatment?

A:

Medicare Part B provides limited coverage for acupuncture sessions for the treatment of lower back pain. According to CMS, Medicare’s decision to include coverage for acupuncture represents the government’s commitment to provide treatment alternatives, helping to reduce the need for opiates for pain relief.

Medicare’s coverage for acupuncture is specifically limited to the treatment of chronic lower back pain. Chronic lower back pain is defined by Medicare as pain lasting twelve weeks or longer, having no identifiable systemic cause (not associated with metastatic, inflammatory, or infectious disease) and pain that is not associated with surgery or pregnancy. The acupuncture treatment must be given by a doctor, or by another health care provider (like a nurse practitioner or physician assistant) who has both of the following:

• A masters or doctoral level degree in acupuncture or Oriental Medicine from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine

• A current, full, active, and unrestricted license to practice acupuncture in the state where care is being provided

Original Medicare will cover up to twelve acupuncture sessions. All must occur within a 90-day window. If the patient does not improve or gets worse, Medicare will not pay for more sessions. Medicare will cover eight additional sessions for a maximum of twenty treatments a year for those whose symptoms improve after the first twelve treatments.

If you are considering acupuncture, take the same steps you would take to choose a specialist:

• Ask your physician for recommendations.

• Interview the practitioner. Ask what is involved in the treatment, how likely it is to help your condition and how much it will cost. • Always verify your coverage and your share of the cost with Medicare or your Medicare Advantage plan before you start receiving treatment. For your questions on insurance, including Life, Health, Medicare Advantage Plans, Medicare Supplements, Vision, Dental and more, call or email me at Lmutsko@mutskoinsurance.com or call 440-255-5700.

Laura Mutsko Mutsko Insurance Services, LLC 6982 Spinach Drive, Mentor, OH 44060 440-255-5700 www.mutskoinsurance.com