Geographic Variation in Utilization of Acupuncture Among Medicare Part B Beneficiaries

Introduction: In 2020 Medicare initiated reimbursement for acupuncture for treatment of chronic low back pain (cLBP), with coverage limited to services provided by physicians and certain clinicians under their supervision. Independent licensed acupuncturists are ineligible for payment. The restrictive terms of coverage may compromise adequate and equitable patient access to acupuncture under Medicare. The purpose of the study was to quantify utilization and treatment intensity of acupuncture for cLBP under Medicare by state. Methods: We employed a cross-sectional design to examine 2020–2023 Medicare claims. We measured Utilization as acupuncture recipients per 100,000 Part B beneficiaries and Treatment Intensity as acupuncture visits per 100,000 Part B beneficiaries. To model utilization and treatment intensity across US states, we estimated Empirical Bayes adjusted rates for each state using Poisson regression models with state-level covariates. Quintiles of rates for utilization and treatment intensity were mapped by state to illustrate geographic variation. Results: Among all states the mean rate of utilization was 235.4 recipients per 100,000 Part B beneficiaries. The mean rate of treatment intensity was 1,721.9 services per 100,000. Utilization appeared relatively higher in West coast, Northeastern, and northern prairie states and states with large urban areas. Conclusions: Utilization and treatment patterns related to acupuncture for Medicare Part B beneficiaries vary widely by state. The marked geographic variation in patient utilization and treatment intensity suggests that access is not equitable. The variation is likely related to both the availability of acupuncture services under Medicare and patient preference.