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.
Please call Moda Health Customer Service at 503-265-4762 or toll-free at 877-299-9062. TTY users, dial 711. Customer Service is available from 7 a.m. to 8 p.m., Pacific Time, seven days a week from October 1 through March 31. (After March 31, your call will be handled by our automated phone system Saturdays, Sundays and holidays.)
Last updated Oct. 9, 2020