May I hire an acupuncturist at my practice and make a pretty penny?

Acupuncture is a treatment that involves inserting thin needles through a person's skin at specific points on the body. This type of service is normally performed in the sphere of pain management.

Covered or non-covered, acupuncture is a great tool for helping your patients cope with pain and other negative aspects.

Medicare Coverage of Acupuncture

Medicare started to cover acupuncture as a treatment for lower back pain, during 2020. They currently cover up to 12 acupuncture treatment sessions for patients with chronic lower back pain, performed within a period of three months. Provision for additional sessions is available for members whose symptoms improve after the first 12 sessions. But bear in mind that a maximum of 20 acupuncture treatments annually are covered.

Chronic low back pain is defined as follows:

• Pain lasting twelve weeks or longer;
• Nonspecific. Has no identifiable systemic cause (e.g., not associated with metastatic, inflammatory, infectious disease, etc.);
• Not associated with surgery and pregnancy.

Medicare will cover acupuncture if the professional dispensing the treatment comply with state requirements and should be one of the following:

• a Physician
• a Physician’s Assistant (PA)
• a Nurse Practitioner (NP)
• a Clinical Nurse Specialist (CNS)
• auxiliary personnel

PA, NP/CNS (as identified in 1861(aa)(5)), and auxiliary personnel may provide acupuncture treatment if they meet state requirements and have:

• A Masters or doctoral-level degree in acupuncture or Oriental Medicine from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine (ACAOM)
• A current, full, active, and unrestricted license to practice acupuncture in a State, Territory, or Commonwealth (i.e., Puerto Rico) of the United States, or District of Columbia

Please note that auxiliary personnel who provide acupuncture must be under the supervision of a physician, PA, or NP/CNS.

Below are the approximate rates, which will differ based on the location. Medicare Part B cost-sharing will be applied. 

Medicare Advantage plans have to provide the same level of coverage as traditional Medicare under similar conditions.

New York State Requirements

Acupuncturists may currently not bill Medicare services, as they are not recognized by CMS.

It is possible, however, for acupuncturists to perform the treatment as auxiliary personnel "incident to" a physician's service in defined situations.

Before employing an acupuncturist, verify your state requirements, as for New York State, licensed physicians who use acupuncture in their professional practice must be certified. That means that the MD provider must have  Acupuncture certification to hire and supervise an Acupuncturist in New York State. http://www.op.nysed.gov/acupuncert.htm

Also, acupuncture does not fall within the nursing scope of practice in New York State (including RN, CNS, NP, or LPN). If an NP wishes to practice acupuncture, they would need to meet the requirements for licensure in that profession, which may be found on this link: http://www.op.nysed.gov/prof/acu.

Source:

https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=295

http://www.op.nysed.gov/acupuncert.htm