Update to Reimbursement for Acupuncture Claims

Acupuncture services administered for any condition other than chronic low back pain are considered non-medical and non-covered by Medicare. Effective Jan. 1, 2023, acupuncture claims submitted for non-medical services will be denied, regardless of whether the member’s plan includes a Wellness Allowance benefit for supplemental acupuncture services.

Medicare-covered acupuncture services for chronic low back pain should be billed using CPT codes 97810, 97811, 97813, 97814, 20560, and 20561, per Section 410.2, Chapter 32, of the Medicare Claims Processing Manual.

Providers can resubmit claims with the appropriate Medicare-covered CPT code(s) if a denial was the result of an error.

CarePartners CareAdvantage Preferred HMO members whose plan has a Wellness Allowance benefit can file a reimbursement request for supplemental acupuncture services not covered by their medical benefit.