Patient Resources
Medicare & Acupuncture: What You Need to Know
Acupuncture is increasingly recognized for its role in managing chronic pain, especially among older adults. Since January 2020, Medicare Part B has covered acupuncture—but only under specific conditions.
What Medicare Covers
- Condition: Chronic low back pain (lasting 12+ weeks, not caused by identifiable disease or surgery)
- Coverage Limit: Up to 12 sessions in 90 days, with an additional 8 sessions if improvement is shown (maximum 20 per year)
- Reimbursement Rate: After meeting the Part B deductible, Medicare pays 80% of the approved amount; patients pay the remaining 20%
Who Can Bill Medicare?
Licensed Acupuncturists (LAc’s) are not Medicare providers. This is because the Social Security Act (SSA) does not currently list licensed acupuncturists as recognized provider types.
Efforts like the Acupuncture for Our Seniors Act aim to change this by amending the SSA.
Submitting Superbills for Reimbursement
When you receive acupuncture here at Grand Rapids Wellness you will pay for your acupuncture visit and you will receive a superbill. You can then submit the superbill to be reimbursed by medicare. Here’s how:
What Is a Superbill?
A superbill is an itemized receipt that includes:
- Patient information
- Provider details (name, credentials, NPI)
- Date of service
- CPT codes (e.g., 97810, 97811)
- Diagnosis codes (ICD-10)
- Total charges
How to Submit
- Get the superbill from your acupuncturist after treatment.
- Complete Medicare’s claim form (CMS-1490S).
- Attach the superbill and any supporting documentation.
- Mail to your local Medicare Administrative Contractor (MAC)—address is listed on the CMS-1490S instructions.