In compliance with the National Coverage Determination (NCD) requirements, ConnectiCare has begun to offer acupuncture for chronic lower back pain as a covered benefit for our Medicare Advantage members since Jan. 1, 2020. This is a benefit offered through our HMO, HMO-POS and HMO D-SNP plans.
Under the new benefit, covered services include up to 12 visits in 90 days for Medicare beneficiaries with chronic lower back, 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 patients demonstrating improvement. No more than 20 acupuncture treatments may be administered annually. Treatment must be discontinued if the patient is not improving or is regressing.
Preauthorization is required after the 12th visit.
Members will need to pay a $30 copay for each visit, unless they are members who are dual eligible for Medicare and Medicaid. Medicaid will pay the member’s cost-share if the dual-eligible members goes to a Medicaid approved provider. Please note, Qualified Medicare Beneficiaries (QMB) cannot be billed.