Coverage updates

When Medicare changes coverage rules

The Centers for Medicare & Medicaid Services (CMS) sometimes change the coverage rules that apply to an item or service. When this happens, CMS issues a National Coverage Determination (NCD). See our NCD notices below.

Acupuncture for chronic low back pain (cLBP)

As of Jan. 21, 2020, Moda Medicare Advantage plans will pay for Medicare-covered acupuncture for chronic low back pain (cLBP).

Members who qualify will be covered for up to 12 visits in 90 days for chronic low back pain that:

  • Lasts 12 weeks or longer
  • Does not have a known cause (it’s not associated with metastatic, inflammatory, infectious or other diseases)
  • Is not associated with surgery
  • Is not associated with pregnancy

Additional visits may be covered if criteria is met.

Acupuncture services must be provided under supervision of a qualified physician. Independent acupuncturists may not qualify. Please contact Customer Service at the number below for assistance finding a provider.

Please note: All types of acupuncture, including dry needling, for any condition other than cLBP will not be covered by Medicare.

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Last updated Sep. 26, 2019
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