Medicare and Acupuncture

Who can practice acupuncture and be reimbursed by Medicare? That is the topic that we cover in this week’s video. Watch now to find out more!

Transcription:

When Medicare recently released their handbook for beneficiaries, for 2021, they included a section about acupuncture and the fact that it was now covered in certain circumstances. And so, of course, our doctors are getting questions, and then you’re calling us and asking, you know, what is this? And how can we get reimbursed for this? And what does this look like? And so this video is really going to cover that we’re not going to cover when it can be covered. And for what, for what exact purposes instead, I want to cover exactly who can do this? Because I think that will answer the vast majority of the question, the short answer is this. Odds are for chiropractic physicians, you’re just simply not going to be able to be reimbursed by Medicare.

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In other words, it’s not going to be reimbursable. Acupuncture is for your Medicare patients. If you perform that task, it’s just really that simple. Now, are there circumstances where it’s possible? Yes, there are going to be certain circumstances extremely limited where they are. And so in this video, I’m going to cover exactly what those protocols are, what the requirements are about, who can actually Bill acupuncture to Medicare and expect reimbursement. So here’s the way it’s laid out. The way they laid it out is they said, who can do this carte blanche show without the additional restrictions and requirements, it’s physicians. But then here’s the bad part, what they did is they referenced their definition of physician. Now, of course, in Illinois, you are physicians, chiropractic physicians are licensed as physicians under the Medical Practice Act of 1987. But under federal law, everything changes. We already know this, we’ve been fighting this, that’s what House Resolution 3654 is designed to correct is the definition of physician. And the way it works is right now, here’s how they have defined in the section that they referenced physicians under Medicare law, it says a physicians may furnish acupuncture in accordance with applicable state regulations, however, then it goes on to say, the term physician when used in connection with the performance of any function or action means a chiropractor, but only with respect to the treatment by means of manual manipulation of the spine to correct a subluxation.

In other words, the only time that Medicare considers chiropractic physicians to be physicians is when you’re actually adjusting the spine to correct a subluxation. That’s it, not for any other services. So under this definition, when we’re talking about acupuncture since acupuncture is not the manual manipulation of the spine to correct a subluxation. Then at that stage, you would not be able to be considered a physician. And so we have to continue to read to see what are the other possibilities then do I fall in a different category, there is another category. And it is for physicians assistants, nurse practitioners, and auxiliary personnel. Now, they have another set of requirements. And for those particular three groups, so PAs, APNs, and auxiliary personnel. So we’re, obviously we’re not physician’s assistants, and we’re not nurse practitioners. And so the only other category that we fall into is that auxiliary personnel category, because again, because of the reasons I just gave a few minutes ago, we’re not physicians, for acupuncture, according to federal Medicare law, for reimbursement purposes. Again, for the state, yes, we’re physicians, but not for the sake of this particular statute.

So then what else? How does this work? What are the requirements for those three groups of people? Well, first of all, you either have to have a master’s or a doctorate level degree in acupuncture or Oriental medicine, from a school accredited by ACA OM. So you have to have a doctorate or master’s degree in acupuncture. That’s clear. And in addition to that, you have to have a current full active, unrestricted license to practice acupuncture in the state. And so ultimately, you have to have an acupuncture license, and you have to have that doctorate and master’s degree, you have to have both in acupuncture. Now, by the way, that’s how we cover the generalities of PAs and an APNs. So the PAs and APNs would also have to have that doctorate or master’s level degree and an unrestricted license to practice acupuncture in the state.

For auxiliary personnel, they actually even go a step further, because remember, now we’re not an APN. We’re not a PA, we’re not a physician under Medicare law for this purpose. So we only fall under auxiliary personnel. So what are the additional restrictions for auxiliary personnel? Well, auxiliary personnel have to be under the appropriate level of supervision. And the supervision has to be performed by an APN, a PA, an MD, or a DO, that’s really the way it comes down. That’s the way it’s crafted into this. Now. Here’s the problem with what they say for the appropriate level of supervision is they point you back to some other provisions of federal law, and those read a lot more restrictive than what you may think. And here’s what it says in general services and supplies must be furnished under direct supervision of the physician or other practitioners. So in this case, APN or PA. However, only the supervising physician or the practitioner may bill Medicare for the incident to services. So in theory, even if you could meet that you can go for it, they would have to be billed under the MD, DO, APN, or PAs license, but then it goes on to say direct supervision in the office setting means the physician, the physician or the other practitioner must be present in the office suite, and immediately available to finish to furnish assistance and direction throughout the performance of the procedure. Well, that clearly indicates that whoever’s doing the supervising must also be must also have full training. Now we already know that APNs and PAs would have to have that master’s or doctorate level anyway, to even do the supervising, right. But even the MDs and DOs would have to have and meet standard of care, to be able to provide acupuncture, so they’re going to have to have training as well. So at the end of the day, what we’re talking about is even the supervision, but has to be performed by somebody who has extensive knowledge and understanding and experience in acupuncture. And that’s the only way so at the end of the day, you know, as we summarize what all of this looks like, ultimately, the only way that a chiropractic physician would be able to actually bill Medicare and expect to have reimbursement wouldn’t be if they, if they’re furnishing the services, right. If your furniture service, you would have to be working under the direct supervision of an MD, DO, APN, or PA, and if it’s APN or PA, then they also have to have that master’s or doctorate level, you would also have to have a master’s or doctorate level, and an acupuncture, acupuncturist licensed in Illinois. So quite candidly, to be able to meet all of these requirements, it just isn’t practical. And yet, and the reality of this is it’s not an Illinois issue. You know, we have an incredibly broad scope of practice, and, and we can even argue about the license. But you can argue about the other two major provisions, which is the master’s doctorate level degree, as well as the supervision requirement that’s in the statute because of the references they give, and what the federal statute indicates in those particular areas.

So at the end of the day, this isn’t an Illinois-specific issue, this is a national issue. And the sheer number of chiropractic physicians across the board that can actually be able to build this and get reimbursed for it are extremely limited. So what do you do in those cases, you know, knowing now that odds are, you’re not going to be able to bill and get reimbursed and, and for the majority of doctors, that’s what we’re talking to when a patient comes in and says, I really want you to go Medicare for these services, says that you can, in these cases, you should append the GY modifier, which tells Medicare that it is not a statutorily covered service. Additionally, if you want to have that extra mile, you could get an ABN form signed right at that stage and, and then also append the GA modifier to the billing as well. But the GY modifier really should take care of you in that particular instance, because it’s not a statutorily covered service because the person who’s performing it can’t statutorily perform that service according to Medicare for reimbursement purposes. So, you could as just an additional protection and send both the GY and the GA modifier to those make sure if you’re appending, the GA modifier that you do get an appropriate level of ABN form signed for acupuncture and leave. That’s what you need to know in regard to Medicare and acupuncture and regards to who can actually perform those services. And we’ll catch you next week.