You've heard this question a million times from patients: "Does Medicare cover acupuncture?" The answer is messy. Medicare started covering acupuncture in 2020, but the rules are confusing and got worse in 2025.
Struggling with Medicare acupuncture billing? We help acupuncturists get paid without the headaches. Call us now and stop losing money to rejected claims.
Most acupuncturists still don't get these rules. That costs them thousands every year. Their patients get mad thinking they have coverage when they don't.
Does Medicare Cover Acupuncture in 2025?
Medicare pays for acupuncture for one thing only: chronic lower back pain. That's it. Your patient has migraines? Too bad. Knee pain? Nope. Anxiety? Forget it.
Here's what counts as chronic lower back pain:
- Hurting for 12 weeks or more
- No obvious cause (not cancer, infection, or swelling)
- Not from surgery or pregnancy
- Only the lower back area
Coverage Limits You Need to Know
| What's Covered | 2025 Limit | The Fine Print |
|---|---|---|
| First Round | 12 visits in 90 days | Better show it's helping |
| Extra Visits | 8 more if getting better | Doctor proves improvement |
| Year Total | 20 treatments max | Can't go over this |
| Session Time | 45 minutes tops | Longer sessions get denied |
Patient not getting better after 12 visits? Medicare cuts them off. No second chances.
Who Can Actually Bill Medicare?
Here's where it gets stupid. Regular acupuncturists can't bill Medicare. The person doing the billing must be:
Can Bill Medicare:
- Medical doctors
- Nurse practitioners
- Physician assistants
But They Also Need:
- Acupuncture degree from approved school
- State acupuncture license
- License must be active and clean
The Weird Workaround
Licensed acupuncturists can work under a doctor's supervision. But the doctor has to do all the billing. The acupuncturist becomes like an employee.
Reality check: Your solo acupuncture practice probably can't take Medicare patients. You need to work with a medical office.
What Medicare Actually Pays in 2025
Here's what Medicare pays for different acupuncture codes:
| Code | What It Is | Medicare Pays | When to Use |
|---|---|---|---|
| 97810 | Regular needles, first 15 minutes | $37.89 | Start of treatment |
| 97811 | Regular needles, next 15 minutes | $28.87 | Longer sessions |
| 97813 | Electric needles, first 15 minutes | $42.22 | Electro treatments |
| 97814 | Electric needles, next 15 minutes | $34.65 | Extended electro |
| 20560 | Dry needles, 1-2 muscles | $26.71 | Trigger points |
| 20561 | Dry needles, 3+ muscles | $39.70 | Multiple spots |
What patients pay: 20% after they hit their deductible.
Real example: 45-minute electric treatment pays about $77. Patient owes around $15.
What Medicare Won't Touch
Don't even think about billing Medicare for acupuncture treating:
- Arthritis
- Headaches
- Stress or depression
- Upset stomach from chemo
- Any other body part pain
- Getting pregnant
- Losing weight
- Quitting smoking
Your Notes Better Be Perfect
Medicare got picky about paperwork in 2025. Every claim needs:
Before Treatment:
- How long the pain lasted
- What other treatments failed
- How bad the pain affects daily life
- Clear back pain diagnosis
During Treatment:
- Exact needle spots
- How deep you went
- How long you treated
- How patient responded
After Treatment:
- Pain scale numbers (1-10)
- What got better or worse
- Can they work better?
- Can they move better?
Bad notes = denied claims. Medicare audits more practices now. Get caught with weak records and you're in trouble.
Medicare Advantage Plans Are Different
Some Medicare Advantage plans cover more than regular Medicare. They might pay for:
- Acupuncture for other pain
- Wellness treatments
- More visits per year
- Regular acupuncturists (not just doctors)
Better Plans to Look For
UnitedHealthcare: Some plans cover acupuncture for pain and nausea.
CareFirst BlueCross BlueShield: Better plans include routine acupuncture.
Humana: Certain plans cover more conditions.
Always double-check: These plans change every year. What works in 2025 might not work in 2026.
Want to cash in on Medicare Advantage patients? We know which plans pay best and how to bill them right. Get started today and boost your income.
2025 Changes That Hurt Practices
New rules in 2025 made things harder:
Prove Other Treatments Failed First
Medicare wants proof patients tried other stuff first:
- Physical therapy for 6+ weeks
- Prescription pain pills
- Over-the-counter pain meds
- Heat and cold packs
- Changed their activities
Harder to Get Approved as Provider
Getting approved to bill Medicare got tougher:
- School accreditation checked more
- License renewals tracked yearly
- Education credits required
- Insurance proof needed
More Audits Coming
Medicare lowered the audit trigger. Bill more than $15,000 in acupuncture per year? You're on their radar. Used to be $25,000.
Help Patients Find Providers
Patients can't find qualified providers. Here's how to help:
Medicare Website Search:
- Go to medicare.gov
- Click "Find care providers"
- Type "acupuncture" and ZIP code
- Call to verify they take Medicare
Medicare Phone Help: Call 1-800-633-4227 for local provider lists.
Check Before Treating: Always verify the patient's exact plan covers acupuncture. Not all Medicare is the same.
What It Costs Patients
Without Medicare, acupuncture costs:
- First visit: $100-150
- Follow-ups: $75-120
- Package deals: Save 10-20%
With Medicare coverage:
- Deductible first: $240 in 2025
- Then 20% of approved amount
- Total for 20 sessions: around $300-400
What's Coming Next
Politicians keep trying to expand Medicare acupuncture:
New Law Being Pushed
The "Acupuncture for Our Seniors Act" would:
- Let regular acupuncturists bill Medicare
- Cover more conditions
- Drop doctor supervision rules
Where it stands: Introduced in 2023, but stuck in committee.
States Making Changes
Some states push for better coverage:
- California: More Medicaid acupuncture
- New York: Testing Medicare Advantage programs
- Florida: State worker plans adding coverage
Smart Moves for Your Practice
Acupuncturists:
- Team up with medical offices for billing
- Market to Medicare Advantage patients
- Build doctor referral network
- Set clear cash-pay policies
Chiropractors:
- Learn acupuncture codes if you do dry needling
- Know when to use which codes
- Write detailed treatment notes
Massage Therapists:
- Medicare doesn't cover massage at all
- Focus on private insurance and cash
- Partner with acupuncturists for referrals
Stop fighting Medicare billing alone. We handle the mess while you treat patients. Call us and get paid what you're worth.
Bottom Line for 2025
Medicare acupuncture coverage stinks, but it's still money on the table. Remember:
- Only chronic lower back pain gets covered
- 20 treatments max per year with tough progress rules
- Most acupuncturists can't bill directly
- Paperwork requirements are brutal
- Medicare Advantage plans offer better options
- Laws might change things later
These rules are confusing on purpose. Many practitioners give up on Medicare entirely. But if you learn the system, you can make good money serving older patients who really need help.
Stay on top of rule changes. Train your staff on documentation. Partner with medical practices if you need to. Your senior patients deserve these treatments, and you deserve to get paid for providing them.
