Are Acupuncture Sessions Covered by Insurance? Find Out Now

Introduction

Acupuncture has grown in popularity as a holistic treatment for pain relief, stress management, and chronic conditions. However, one major question remains: Are acupuncture sessions covered by insurance? And what is the acupuncture price if they aren’t?

The answer depends on multiple factors, including your insurance provider, policy type, and the medical necessity of acupuncture treatment. This guide will help you understand:

• Which insurance plans cover acupuncture

• How to check your coverage

• Costs of acupuncture sessions

• Steps to maximize your insurance benefits

By the end of this article, you’ll know exactly how to determine whether your insurance plan covers acupuncture and how to avoid unexpected out-of-pocket costs.

Does Insurance Cover Acupuncture?

The coverage for acupuncture treatments varies across different insurance providers and plans. Here’s a breakdown of common scenarios:

1. Insurance Plans That Typically Cover Acupuncture

Some health insurance plans include acupuncture as part of their benefits, particularly if it is deemed medically necessary. These plans often cover acupuncture:

• Employer-Sponsored Health Plans: Some companies offer plans that include alternative medicine, including acupuncture.

• Medicare (Partial Coverage): Medicare Part B covers acupuncture for chronic lower back pain, but only up to 12 sessions within 90 days. If improvement is shown, 8 additional sessions may be covered.

• Medicaid (Varies by State): Some state Medicaid programs include acupuncture, but coverage is inconsistent.

• Private Insurance Plans: Certain individual and family plans cover acupuncture, especially if recommended by a doctor.

• Affordable Care Act (ACA) Marketplace Plans: Some ACA plans include acupuncture, but it's essential to check the specifics of your plan.

2. Insurance Plans That Do Not Cover Acupuncture

Many traditional insurance plans classify acupuncture as an elective or alternative treatment, meaning they may not cover it unless:

• It is prescribed by a doctor for pain management or other conditions.

• It is part of a comprehensive treatment plan.

Always check with your provider to confirm what is and isn’t covered.

How to Verify If Your Insurance Covers Acupuncture

Before booking an acupuncture session, follow these steps to determine if your insurance covers the treatment:

1. Check Your Insurance Policy

• Log in to your insurance provider’s online portal and review your Summary of Benefits and Coverage (SBC).

• Look for keywords like “alternative medicine,” “acupuncture,” or “complementary therapies.”

• Identify copayments, deductibles, and coverage limits.

2. Contact Your Insurance Provider

Call the customer service number on your insurance card and ask:

• Is acupuncture covered under my current plan?

• Do I need a referral from my primary care doctor?

• Is there a limit on the number of sessions covered per year?

• What are the out-of-pocket costs (copays, deductibles, coinsurance)?

• Are there specific conditions for coverage (e.g., chronic pain, migraines)?

3. Verify Provider Eligibility

• Some insurance companies require you to visit in-network acupuncture practitioners.

• Check if your preferred acupuncturist accepts your insurance or if they offer superbills for reimbursement.

4. Request Preauthorization (If Required)

Some plans require preauthorization before covering acupuncture sessions.

• Have your doctor submit a request, explaining the medical necessity.

• Get written confirmation from your insurer before starting treatment.

How Much Do Acupuncture Sessions Cost Without Insurance?

If your insurance doesn’t cover acupuncture, you’ll need to pay out of pocket. Here’s a breakdown of the average acupuncture price in the U.S.:

• Initial consultation + first session: $75 - $200

• Follow-up sessions: $50 - $150 per visit

• Package deals (multiple sessions): Discounts may be available if you prepay for a set number of visits.

Factors Affecting Acupuncture Costs

Several factors impact acupuncture pricing:

• Location: Sessions in major cities tend to be more expensive than in rural areas.

• Practitioner’s Experience: More experienced acupuncturists often charge higher fees.

• Session Duration: Treatments range from 30 to 90 minutes, affecting cost.

• Specialized Treatments: Some conditions require additional techniques, increasing the price.

How to Save Money on Acupuncture Treatments

If your insurance doesn’t cover acupuncture, consider these strategies:

1. Use Health Savings Accounts (HSA) or Flexible Spending Accounts (FSA)

• Acupuncture is considered an eligible medical expense under HSA and FSA accounts.

• You can use pre-tax dollars to cover the cost, reducing your financial burden.

2. Find Acupuncturists Offering Sliding Scale Pricing

• Some clinics offer income-based pricing to make acupuncture more affordable.

3. Look for Community Acupuncture Clinics

• Community acupuncture centers offer low-cost group treatments (typically $20-$50 per session).

4. Ask About Payment Plans or Discounts

• Some practitioners offer membership programs or bulk session discounts.

Common Insurance Codes for Acupuncture Billing

If you need to submit a reimbursement request, knowing the correct CPT (Current Procedural Terminology) codes is essential. Common acupuncture billing codes include:

• 97810: Initial acupuncture session (first 15 minutes)

• 97811: Follow-up acupuncture session

• 97813: Initial session with electrical stimulation

• 97814: Follow-up session with electrical stimulation

Make sure your acupuncturist provides an itemized invoice with these codes for insurance claims.

FAQs

1. Can I use Medicare to pay for acupuncture?

Yes, but only for chronic lower back pain, and coverage is limited to 20 sessions per year.

2. Does Blue Cross Blue Shield cover acupuncture?

Some BCBS plans cover acupuncture, but coverage varies by state and policy. Contact them directly to confirm.

3. How much does acupuncture cost with insurance?

If covered, you may only need to pay a copay ($20-$50) or coinsurance (10%-50%) per session.

4. What if my insurance denies my acupuncture claim?

You can appeal the decision by:

• Requesting a letter of medical necessity from your doctor.

• Providing detailed invoices and medical records.

5. Can I get acupuncture coverage through workers’ compensation?

Some states include acupuncture under workers’ compensation for injury recovery. Check your local laws.

Final Thoughts: Is Acupuncture Covered by Insurance?

While acupuncture coverage varies by insurance provider, many policies offer partial or full coverage if deemed medically necessary. To maximize your benefits and understand the acupuncture price:

 Review your insurance plan carefully
Contact your provider to verify coverage details
Choose an in-network acupuncturist
Use HSA/FSA funds for cost savings
Explore affordable acupuncture clinics if not covered

Taking these steps ensures that you receive the benefits of acupuncture without unexpected expenses.