There is no direct payment to an LAc at this time and Medicare will not register any LAc to the Medicare program. However, this unprecedented ruling does now include acupuncture under Medicare. But with the following protocols.

1. The LAc would have to be employed and work incident to an MD, PA or NP.
2. There is no direct payment to the LAc or Medicare registration but paid to the medical provider and the acupuncturist must be an employee.
3. It is limited to chronic lower back pain for 12 weeks or greater and up to 20 visits in a year (12 visits within 90 days and if it is effective up to an additional 8).
For the purpose of this decision, chronic low back pain (cLBP) is defined as:
i. Lasting 12 weeks or longer;
ii. nonspecific, in that, it has no identifiable systemic cause (i.e., not associated with metastatic, inflammatory, infectious, etc. disease);
iii. not associated with surgery; and
iv. not associated with pregnancy.

4. The AAC Insurance Information Network interprets this as a start and a study to determine the effectiveness of acupuncture and should lead to a positive outcome. This should lead to Medicare allowing full membership and direct claims from LAc providers just as the VA has done.
5. This level of coverage was not expected as it was announced that there would be a “study” only so certainly the fast track bodes well for the future of acupuncture in the Medicare program.
6. Acupuncture will be reimbursed in the range of $40-50 per set depending on your region.

The AAC Insurance Information Network is your partner and will be addressing this topic in detail at all of our upcoming Advanced Insurance Seminars relating to this new protocol and how it can be utilized and implemented.


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