Medicare services and coverage details

Last Updated May 2023

The Blue Cross North Carolina (Blue Cross NC) provider directory is created from information provided by our network providers, facilities and third parties. We try to provide you with the most up-to-date and accurate provider lists. However, providers are added to our network often and sometimes decide not to participate in our network. We cannot always guarantee that these provider lists are accurate or current when you search.

Legislative changes in the Social Security Act now allow for coverage of acupuncture services under MA plans when specific clinical and professional criteria are met.  Under the updated legislation, Blue Cross NC covers acupuncture for chronic low back pain under section 1862(a)(1)(A) of the Social Security Act for our Medicare Advantage Plans. More information can be found at Decision Memo for Acupuncture for Chronic Low Back Pain (CAG-00452N) (cms.gov).

Under updated legislation, Blue Cross NC will cover acupuncture services for chronic low back pain under section 1862(a)(1)(A) of the Social Security Act for our Medicare Advantage Plans.  Up to 12 visits in 90 days are covered for Medicare beneficiaries under the following circumstances:

For the purpose of this decision, chronic low back pain (CLBP) is defined as:

• Lasting 12 weeks or longer;
• Nonspecific, in that it has no identifiable systemic cause (i.e. not associated with metastatic, inflammatory, infectious, etc. disease);
• Not associated with surgery; and
• Not associated with pregnancy.
• An additional eight sessions will be covered for those patients demonstrating an improvement.  No more than 20 acupuncture treatments may be administered annually.
• Treatment must be discontinued if the patient is not improving or is regressing.

Blue Cross North Carolina (Blue Cross NC) does not credential or contract directly with acupuncture providers, however, we are asking our participating MA providers to self-report their ability to offer acupuncture services. Below, you will find providers that have indicated that they may perform some acupuncture services. To be covered, these services still need to meet the criteria outlined by Centers for Medicare and Medicaid Services (CMS). Members should contact the provider directly to ensure these services are offered.

Providers listed are contracted with both HMO and PPO products for Medicare Advantage.