Does Medicare cover acupuncture?

Medicare covers acupuncture, including dry needling, only for chronic low back pain. Your pain must meet all of these tests:

• It has lasted 12 weeks or longer.
• It has no known cause in the rest of your body. For example, it is not from cancer that has spread, or from an infection or an inflammatory disease.
• It is not linked to surgery.
• It is not linked to pregnancy.

Acupuncture for anything else is not covered. That includes neck pain, knee pain, arthritis, headaches, nausea, and stress.

In short: long-term low back pain with no clear cause. Nothing else.

• First round: up to 12 visits in 90 days.
• Second round: 8 more visits, but only if you are getting better.
• Yearly limit: 20 visits in all.

If you are not getting better, or you are getting worse, treatment must stop. Medicare will not pay for more visits. If you keep going, you pay 100% of the cost.

The year does not follow the calendar. It starts with the month of your first visit. Medicare's own example: if your first visit is March 21, your next year starts March 1 the following year.

Providers bill these visits with codes 97810, 97811, 97813, 97814, 20560, or 20561. Visits 13 to 20 carry an extra code (the KX modifier). It tells Medicare the extra visits are medically needed and that your records show why.

This rule surprises many people. Medicare cannot pay a licensed acupuncturist directly. Your acupuncture must come from one of these:

• A doctor (MD or DO), following your state's rules.
• A nurse practitioner, physician assistant, or clinical nurse specialist who has a master's or doctoral degree in acupuncture or Oriental Medicine from an accredited school, and a current, full, unrestricted state license to practice acupuncture.
• A licensed acupuncturist with that same degree and license, working under the supervision of a doctor, nurse practitioner, physician assistant, or clinical nurse specialist who bills Medicare.

A chiropractor cannot bill Medicare for acupuncture. Medicare covers only spine adjustments from a chiropractor. See chiropractors.

Once you meet the $283 Part B deductible for 2026, you pay 20% of the Medicare-approved amount for each covered visit. Medicare pays the rest.

• Visits over the limit, or for other conditions: you pay 100%.
• If you have a Medigap plan: every plan pays some or all of your 20% share for covered visits.
• If you have Medicare Advantage: your plan sets its own copay. Some plans cover acupuncture for more conditions as an extra benefit. Check your plan's Evidence of Coverage.
• If you have Medicaid too: Medicaid may pay your share. Ask your state Medicaid office.

1. See your doctor about your back pain. Make sure your record shows how long you have had it and that no other cause was found.
2. Find a provider who can bill Medicare for acupuncture. Ask: "Will you bill Medicare, and who is the billing provider?" A clinic where acupuncturists work with a doctor or nurse practitioner may be able to.
3. Count your visits. Track your 12 visits in 90 days and your 20 a year.
4. Watch for the ABN form. If the provider thinks Medicare will not pay, they may ask you to sign an Advance Beneficiary Notice. It means you agree to pay if Medicare says no.
5. If Medicare says no, appeal. Your Medicare Summary Notice explains how.

In short: the right diagnosis, the right provider, and a close count of your visits.