Medicare and Acupuncture: New Bill Would Expand Coverage

In recent years, there have been tremendous advances in legislation expanding the coverage that Medicare provides to millions of seniors around the country. In particular, expanding coverage to include holistic medicine has been most notable with the recognition—albeit limited recognition—of acupuncture services to treat chronic lower back pain which happened in early 2020. This relationship between Medicare and acupuncture is vital to providing the benefits of holistic treatment to millions of seniors!

About a year and a half later, in July 2021, another piece of legislation was introduced in the 117th Congress: legally classified as HR 4803, the Acupuncture for Seniors Act was written and sponsored by California Representative Judy Chu and would expand Medicare coverage of acupuncture in a few key manners.

Let’s dive into how this Act would impact acupuncture, both as a practice in its own right and in terms of your holistic practice.

HR 4803 Would Expand Medicare Coverage of Acupuncture

The Acupuncture for Seniors Act, known officially as HR 4803, would greatly impact the connection between Medicare and acupuncture by classifying licensed acupuncturists as Medicare providers who are qualified to provide services without supervision.

This kind of recognition from Medicare means that acupuncturists would be able to deliver care to more than 60 million Medicare beneficiaries. Plus, granting Medicare-provider status would streamline the medical billing process because acupuncturists would be able to bill Medicare directly instead of going through the physician-supervised requirement.

HR 4803 defines “qualified acupuncturists” as individuals who have state licensure or are certified by a nationally recognized authority, which helps providers who operate in states without a state license opportunity. Once again, this inclusive definition streamlines the patient-provider relationship and would make all licensed, certified acupuncturists able to serve Medicare patients.

Overall, the Acupuncture for Seniors Act would facilitate cost-effective and high-quality care to millions of people while encouraging the growth and development of acupuncture as a holistic practice and in communities around the country.

Current Status of Medicare and Acupuncture

The current status of Medicare and acupuncture is limited in comparison to what the Acupuncture for Seniors Act would do. At present, Medicare beneficiaries may be treated for chronic lower back pain, defined as:

• 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

Medicare will cover up to 12 visits in a 90 day period; if the patient demonstrates improvement, then Medicare will cover an additional 8 visits but treatment is not to exceed 20 treatments in an annual period.

CMS clarifies that “physicians, physician assistants, nurse practitioners/clinical nurse specialists, and auxiliary personnel may furnish acupuncture if they meet all applicable state requirements and have:

• A master or doctoral-level degree in acupuncture or Oriental Medicine from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine (ACAOM); and
• current, full, active, and unrestricted license to practice acupuncture in a State, Territory, or Commonwealth (i.e. Puerto Rico) of the United States, or District of Columbia.”

In comparison, HR 4803 would significantly broaden the scope of care and the definition of who can provide acupuncture treatments—a huge win for Medicare and acupuncture!

How This New Bill Would Impact Your Acupuncture Practice

The Acupuncture for Seniors Act would tremendously benefit your acupuncture practice because you’d be able to treat patients with Medicare without the need for physician supervision—plus you’d be able to bill Medicare directly for these treatments.

This means that you can grow your practice to treat a whole population of people with a specific type of coverage that otherwise would have had to pay out of pocket for acupuncture treatments. And the ability to bill Medicare directly for these treatments translates to a streamlined revenue cycle management process for your practice!

Furthermore, this expansion of acupuncture services to be covered under Medicare validates and amplifies your efforts to deliver great care to the members of your community with a non-opioid, non-invasive treatment for pain. Perhaps this is the most important point of it all: providing holistic care that can radically improve patients’ quality of life and effectively function as a prescription alternative.

Proven Benefits of Acupuncture Treatments

Acupuncture provides a whole host of benefits, including:

Effective Pain Management

Acupuncture has been recognized for its effectiveness in treating pain, both chronic and acute. In fact, according to the National Institute of Health (NIH), several studies have found that such holistic treatments were proven to reduce pain for a variety of conditions and even manage constant pain such as low-back pain, neck pain, and osteoarthritis/knee pain.

Furthermore, in 2017, the American College of Physicians issued recommendations for treating patients who live with enduring lower back pain, including acupuncture as a proven drug-free treatment plan.

Proven Alternative to Opioid Drug Usage

As providers strive to reduce prescribing opioid drugs to manage pain, patients are directed to therapies like acupuncture as a holistic alternative that maintains an effective pain management quality. This is vital because a recent survey reveals that 49% of people reported knowing someone who has been addicted to prescription opioids; in other words, opioids are not to be taken lightly.

General Health and Wellness Benefits

While the NCCIH notes that acupuncture treatments have been proven to help treat lower back pain, neck pain, osteoarthritis, knee pain, and chronic migraines, the Acupuncture Evidence Project reviewed the effectiveness of acupuncture for 122 treatments over 14 clinical areas and have found some evidence of effect for 117 conditions. These include:

• High or low blood pressure
• Chemotherapy side effects and symptoms associated with it
• Facial pain, including dental pain

Optimize Your Acupuncture Practice’s Revenue Cycle with Holistic Billing Services!

Medicare’s expansion to include acupuncture would provide a huge benefit to your acupuncture practice and could bring in a whole new group of potential patients; how exciting! Want to optimize your practice’s revenue cycle? Partner with an expert medical billing firm!

At Holistic Billing Services, we deal exclusively with holistic healthcare practices that deliver acupuncture, massage therapy, and chiropractic treatments to communities around the country. Whether you have questions on acupuncture insurance billing or other methods to enhance your revenue cycle management, feel free to contact our team today and let us know how we can help your acupuncture practice.