PacificSource follows original Medicare coverage for acupuncture treatment for Medicare Advantage members.

• Medicare will cover up to 20 visits
• Care to be provided by a licensed MD or DO with a license to practice acupuncture
  • PacificSource will allow incident to billing for Medicare covered acupuncture
• Benefit limited to a diagnosis of Low Back Pain M54.5
• $25 member cost share on all plans

Please visit https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=295 to view the original memo.

Should you need additional benefit information, please contact our Customer Service Department.