Is Acupuncture Covered by Health Insurance? A Complete Guide
Acupuncture is an effective, natural therapy for pain relief, stress reduction, and overall well-being. But before scheduling a session, many people ask:
👉 “Will my health insurance cover acupuncture?”
The answer isn’t always straightforward. Coverage depends on your insurance provider, diagnosis, and network status. In this guide, we’ll break down everything you need to know to help you maximize your benefits and reduce out-of-pocket costs.
1. Does Private Health Insurance Cover Acupuncture?
✅ Yes, but with limitations.
Most PPO and HMO plans now include acupuncture as part of their benefits. However, coverage depends on factors such as:
🔹 Diagnosis Restrictions
Not all conditions qualify for coverage. The most commonly covered diagnoses include:
✔ Chronic Lower Back Pain
✔ Migraines & Tension Headaches
✔ Osteoarthritis & Joint Pain
✔ Post-Surgical Pain Management
💡 Tip: If you’re seeking treatment for conditions like anxiety, digestive issues, or infertility, check with your provider to see if they’re covered.
🔹 Treatment Session Limits
Many insurance plans cap the number of sessions they cover per year, typically:
10-20 visits annually
Some require pre-authorization before you can begin treatment.
💡 Tip: If you need more sessions, you may be able to appeal for additional coverage.
🔹 In-Network vs. Out-of-Network Providers
In-Network Providers → Covered at a lower cost, often with a fixed copay.
Out-of-Network Providers → Might still be covered but with higher deductibles and lower reimbursement rates.
💡 Tip: Check your provider directory to ensure your acupuncturist is in-network to save on costs.
2. Does Medicare Cover Acupuncture?
✅ Partially. Medicare has started covering acupuncture, but only for specific conditions.
🔹 What Medicare Covers
Medicare only covers acupuncture for chronic lower back pain, with the following conditions:
✔ The pain must have persisted for 12 weeks or more.
✔ The pain must not be related to surgery or cancer.
✔ Medicare will cover up to 12 sessions in 90 days.
✔ If there’s an improvement, an additional 8 sessions may be approved, with a maximum limit of 20 sessions per year.
🔹 What Medicare Doesn't Cover
❌ Acupuncture for conditions like migraines, arthritis, anxiety, or fertility.
❌ Acupuncture performed by a licensed acupuncturist. (Only physicians are currently covered.)
💡 Future Update: Organizations like the American Society of Acupuncturists are working to expand Medicare coverage to include licensed acupuncturists.
💡 User Tip: If you have Medicare Advantage (Part C), you may have additional coverage beyond Original Medicare. Check with your provider to see if they include acupuncture as an extra benefit.
3. Does Medicaid Cover Acupuncture?
Coverage varies by state. Unlike Medicare, which follows federal rules, Medicaid is state-regulated, meaning each state sets its own policies regarding acupuncture coverage. Some states offer full or partial coverage, while others exclude it entirely.
🔹 States That Cover Acupuncture
Some states have recognized acupuncture as a valuable treatment and included it under Medicaid for pain management and other conditions. Coverage may vary depending on the state’s Medicaid plan and managed care organizations (MCOs).
✔ California – Covers acupuncture for pain management, including chronic pain, post-surgical pain, and some musculoskeletal conditions.
✔ Oregon & Washington – Provides broader coverage, including chronic pain, migraines, and opioid addiction treatment.
✔ New York – Offers limited coverage under certain Medicaid-managed care plans, usually requiring a doctor’s referral.
✔ Minnesota – Covers acupuncture for pain relief and substance use disorders as part of Medicaid’s integrative health services.
✔ Massachusetts – Covers acupuncture services for opioid use disorder treatment under certain Medicaid plans.
💡 “Do I need a referral for Medicaid-covered acupuncture?"
✔ In many US states, yes. You may need a doctor’s referral or prior authorization from Medicaid before receiving coverage
🔹 Which States That Do NOT Cover Acupuncture
❌ Some states do not offer acupuncture benefits under Medicaid, meaning patients must pay out-of-pocket or seek alternative funding. However, Medicaid coverage is constantly evolving, and some states are considering adding acupuncture for chronic pain and opioid addiction treatment.
💡 User Tip: Call your state’s Medicaid office or check their website to see if acupuncture is covered and what conditions qualify.
🔹 Medicaid Alternative Options for Acupuncture
If Medicaid in your state doesn’t cover acupuncture, here are a few alternatives:
✔ Sliding Scale Clinics – Some acupuncture clinics offer reduced pricing for Medicaid patients.
✔ Community Acupuncture Centers – Provide affordable treatments in a group setting.
✔ Federally Qualified Health Centers (FQHCs) – Some offer acupuncture as part of their integrative health services.
4. Does the VA Cover Acupuncture for Veterans?
✅ Yes! The VA offers acupuncture services.
🔹 How Veterans Can Get Acupuncture Coverage
✔ Covered under the VA Community Care Network (CCN)
✔ Available for pain, PTSD, anxiety, and other conditions
✔ Performed by licensed acupuncturists (no physician requirement!)
💡 Tip: Veterans should request acupuncture treatment through their VA primary care provider to see if they qualify.
5. How to Check If Your Health Insurance Covers My Acupuncture Therapy
Before booking an appointment, follow these steps to verify your acupuncture benefits:
🔹 Step 1: Call Your Insurance Provider
Ask them these key questions:
✔ Is acupuncture covered under my plan?
✔ What conditions qualify for coverage?
✔ How many sessions are covered annually?
✔ Do I need a referral from my doctor?
✔ Is my acupuncturist in-network or out-of-network?
🔹 Step 2: Check Your Insurance Portal
Many insurers have online portals where you can review policy details and provider directories.
💡 Tip: Save a copy of your benefits summary for reference.
6. What If My Insurance Doesn’t Cover Acupuncture?
If your insurance doesn’t cover acupuncture, you still have options to reduce costs:
🔹 Use an FSA or HSA Account – Flexible Spending Accounts (FSA) and Health Savings Accounts (HSA) let you pay for acupuncture tax-free, covering co-pays, deductibles, or full treatment costs.
🔹 Look for Cash Discounts – Many acupuncturists offer discounted rates for self-paying patients, making treatments more affordable.
🔹 Ask About Reimbursement – Some insurers allow out-of-pocket payments with the option to submit a Superbill (detailed receipt) for partial reimbursement.
💡 Tip: Always check with your insurance provider before assuming you can get reimbursed!
This version keeps it concise, easy to read, and to the point while maintaining important details! 🚀 Let me know if you need any tweaks. 😊
7. How to Submit an Insurance Claim for Acupuncture
If your insurance allows claims for acupuncture, follow these steps:
🔹 Step 1: Request a Superbill from Your Acupuncturist
This document should include:
✔ Diagnosis & Treatment Codes (CPT Codes)
✔ Total Cost of Services
✔ Your Provider’s NPI Number
🔹 Step 2: Submit Your Claim
Use your insurer’s online portal or fill out a paper claim form.
Attach the Superbill and any required documents.
Submit and wait for reimbursement processing (this can take 2-4 weeks).
💡 Tip: If your claim is denied, you can appeal the decision with additional medical documentation.
Final Thoughts: Navigating Acupuncture Insurance Coverage
Understanding insurance coverage for acupuncture can be complex, but with the right approach, you can make the process easier and cost-effective.
✅ Check with your provider before your first session.
✅ Confirm diagnosis eligibility & visit limits.
✅ Use alternative payment options (HSA, FSA, or reimbursement programs).
At Get Very Well, we help you navigate your insurance benefits to make acupuncture as accessible as possible. Contact us today to verify your coverage and book your first session!