UCLA Medicare (HMO) & Acupuncture

Coverage Overview

A UCLA Medicare HMO plan is a Medicare Advantage HMO, which means two things shape the acupuncture benefit: the Medicare floor that every Medicare Advantage plan must meet, and the HMO rules about staying in network and getting a referral. Our West LA clinic is the closest of our three to the UCLA campus and medical centre. Nature Acupuncture & Herbs accepts UCLA Medicare HMO patients.

On an HMO, network and referral requirements are usually stricter than on a PPO, and they are the part most likely to catch a patient out. Medicare itself covers acupuncture for chronic low back pain within set limits, and a plan may add more. Before your first visit we confirm both the medical benefit and the HMO logistics, so a covered treatment does not get denied on a technicality.

What's Typically Covered

• ◈West LA clinic is closest to the UCLA campus
• ◈Medicare floor applies for chronic low back pain
• ◈Referral and network requirements checked before your first visit
• ◈Billed with standard acupuncture CPT codes
• ◈Also accepted at our Hawthorne and Lynwood clinics
• ◈We tell you what is covered before you are treated, not after

How to Check Your Own UCLA Medicare (HMO) Benefit

Plan documents are written for the plan, not for you. Two people with the same carrier on their card can have completely different acupuncture benefits, because the employer chooses the design. Anything below describes what the carrier publishes; only a call against your own member ID tells you what you have.

Before you call

• ◈Your member ID and group number, both on the front of your card
• ◈The member services phone number from the back of your card
• ◈Your date of birth and the subscriber name, if the plan is not in your name
• ◈A rough description of what you want treated, and how long you have had it

What to ask, word for word

1. 1.“Is acupuncture a covered benefit on my plan, and does it need prior authorization or a referral?”
2. 2.“Are CPT codes 97810, 97811, 97813 and 97814 covered, and how many units per visit?”
3. 3.“How many acupuncture visits am I allowed per year, and how many have I used?”
4. 4.“What is my copay or coinsurance for acupuncture, and does my deductible apply first?”
5. 5.“Is a licensed acupuncturist (L.Ac.) an eligible provider type, or must it be an MD or DC?”
6. 6.“Does coverage depend on the diagnosis, and which conditions are eligible?”