Right forum for Medicare question/back pain acupuncture

[yorkriver1]

What is your experience with low back pain acupuncture claimed on MedSupps?
My client was given a form to fill out, but I think the practitioner is purely an acupuncturist. Medicare rep and the CMS guidelines I found state the narrow band for this to work, first being the nature of the pain, low back not responding to other treatment, if I recall correctly.
Doctor, PA or NP participating in Medicare, also holding one of 2 very specific acupuncture professional designations. One of my family members was able to claim the service on their MedSupp, so it's not a unicorn. I am not their agent, so I wasn't involved, only told about it later. It worked, too.

 

[somarco]

Medicare Part B (Medical Insurance) covers up to 12 acupuncture visits in 90 days for chronic low back pain.

Medicare covers an additional 8 sessions if you show improvement. If you aren't showing improvement, Medicare won't cover your additional treatments and they should be discontinued. You can get a maximum of 20 acupuncture treatments in a 12-month period.

Note
Not all providers can give acupuncture, and Medicare can't directly pay Licensed Acupuncturists for their services. Medicare also doesn't cover acupuncture (including dry needling) for any condition other than chronic low back pain.
https://www.medicare.gov/coverage/acupuncture



It's possible the form tendered is the ABN form . . . only applies to original Medicare, not MA

https://www.ambrygen.com/file/material/view/1436/ABNEnglish2023v508 current.pdf

 

[kgmom219]

Fill the claim form out, send it in and pray

“Acupuncture, Chiro and Podiatrists: Find one that accepts Original Medicare AND files the claims or run away. Otherwise, you’ll never get reimbursed”. Moms Medicare 101, slide 9