Medicare Advantage (MA) Coverage Change for Acupuncture

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. More information is at Decision Memo for Acupuncture for Chronic Low Back Pain (CAG-00452N) (cms.gov) and outlined below under “Additional Information”. 

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) does not credential or contract with Acupuncture providers, however,  we are asking our participating MA  providers to self-report their ability to offer acupuncture services.  This will enable us to display on our Find a Doctor portal those participating providers that offer acupuncture services.  

If your  practice offers acupuncture services, please provide practice information and respond to the questions below via email at [ AcupunctureServiceOfferingMA@BCBSNC.COM ]. 

Practice Information

• Group Practice/Provider Name 
• Type 1 or 2 NPI (Billing NPI) 
• Contact Name and Email 

Questions for Providers 

1. Do you have MDs in your practice who perform acupuncture? 
2. Do you have Physician Assistants, Nurse Practitioners/Clinical Nurse Specialists who perform acupuncture? 
3. Do you have auxiliary personnel such as Acupuncturists or Physical Therapists who perform acupuncture? 
4. If yes to either question (2-3), please confirm if service provider has (1) 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); (2) and 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. 
5. If yes to question 3, do your auxiliary personnel operate under direct supervision? 

Additional Information 

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.  Up to 12 visits in90 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. 

Who can perform the service? 

• Any MD 
  
• Any Physician Assistant, Nurse Practitioner/Clinical Nurse Specialists who have the following education: 
  
  • 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); and 
  • 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. 
• Auxiliary Personnel such as Acupuncturist*, Physical Therapists and Chiropractors who are working under the appropriate supervision and who also have the following education: 
  • 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); and 
  • 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. 
• Auxiliary Personnel are not able to file the claim directly to Blue Cross NC.  The claim must be filed under the supervising physician.  

*Please note:  Blue Cross NC does not credential or contract directly with Acupuncturists.