Traditional Medicare statutorily only covers acupuncture for low back pain. It will provide up to 12 visits in 90 days with up to eight additional visits if improvement is documented. However, to qualify for reimbursement of statutory Medicare services the acupuncture must be performed by an MD, DO, NP, or PA, or auxiliary personnel (which can include an acupuncturist) working incident to the primary provider, and billed by the MD/DO/NP/PA under their NPI number. This excludes most stand-alone acupuncturists from billing Medicare for acupuncture services.
However, above and beyond the statutory Medicare acupuncture coverage above, Medicare Advantage Plans (“MAPs”) may also provide supplemental coverage of services not covered by Medicare. This can include acupuncture performed by stand-alone acupuncturists and billed under their NPI for chronic pain. MAP carriers are required to pay acupuncturists under these supplemental benefits at a floor of the Medicare fee schedule, but nothing precludes the MAP from paying a higher rate.
In early 2026 a trend arose in multiple state wherein MAP carriers were retroactively repricing the supplemental acupuncture to the Medicare Fee Schedule and attempting to recoup payments for non‑Medicare‑covered acupuncture supplemental benefits. Because stand‑alone acupuncturist services are statutorily excluded under Medicare, the Medicare Fee Schedule and sequestration rules should not automatically apply. Supplemental benefits should be governed by contract law, the insurance plan and state insurance law, not Medicare coverage rules.
If you find yourself in this situation, hire a healthcare attorney to review the plan documents, your specific state laws, and determine if there is a legal strategy to defend the recoupment. If state law applies to these supplemental benefits, many states have statutes that limit the recoupment look back to 12-18 months, require detailed notification of the recoupment basis, and provide multiple levels of appeal to defend the recoupment. Furthermore, many state laws prohibit the carrier from offsetting future claims until all appeals are exhausted – which is a mechanism to stop the carrier from repaying themselves while you fight the recoupment.
Please be aware that Medicare, as well as many state laws, require exhaustion of appeals prior to filing suit. Thus, if you are contemplating legal action to fight the recoupment, make sure you appeal the recoupment notices and exhaust the required appeals under the plan.
Disclaimer: The author of this article is an independent person of the National Association of Chiropractic Attorneys / Association of New Jersey Chiropractors and his views are not authorized, sponsored, or otherwise approved by these organizations. The information provided is for general guidance on matters of interest only and may not take into account particular facts relevant to your individual situation. The application and impact of laws and health care can vary widely based on the specific facts involved. Given the changing nature of laws, rules and regulations, there may be omissions or inaccuracies in information contained in these materials. Accordingly, the information you receive is provided with the understanding that the author and NACA / ANJC are not herein engaged in rendering legal, accounting, tax, health care or other professional advice and services nor are they providing specific advice with regard to your practice, the treatment of any specific illness, disease, deformity or condition, or any other matter that affects trade, commerce, or legal rights of others. As such, this article should not be used as a substitute for consultation with professional accounting, tax, legal, health care, or other competent advisers. Before making any decision or taking any action, you should consult an appropriately trained professional.
