Acupuncture has long existed as a non-covered service for Medicare beneficiaries. A recent National Coverage Determination (NCD) reconsideration yields a finalized decision to cover acupuncture for Medicare patients suffering from chronic low back pain.
To aid in this reconsideration, CMS conducted a review of published medical literature to determine if acupuncture for chronic nonspecific low back pain was reasonable and necessary. The coverage decision follows an assessment of the benefits and harms of acupuncture as well as consideration of the current opioid public health crisis.
HHS Secretary Alex Azar said, “Expanding options for pain treatment is a key piece of the Trump Administrations’ strategy for defeating our country’s opioid crisis.” “President Trump has promised to protect and improve Medicare for our seniors and to decide to cover this new treatment option is another sign of that commitment. Medicare beneficiaries will now have a new option at their disposal to help them deal with chronic low back pain, which is a common and sometimes debilitating condition.”
The evidence reviewed for this decision supports clinical strategies that include nonpharmacologic therapies for chronic low back pain. Evidence shows that while the number of adults 65 years of age or older that enrolled in published acupuncture studies is small, patients with chronic low back pain in these studies showed improvements in function and pain. CMS notes too that while there is variation in covered indications and frequency of services, many large private payers provide some coverage of acupuncture for certain indications.
CMS’ decision to cover acupuncture means one more weapon in the arsenal for Medicare beneficiaries suffering from chronic low back pain and one more front-line alternative to prescription opioids. A clear win.
Note: **The recent decision will cover up to 12 sessions in 90 days with an additional eight sessions for those patients with chronic low back pain who demonstrate improvement.
Resources:
Press Release: https://www.cms.gov/newsroom/press-releases/cms-finalizes-decision-cover-acupuncture-chronic-low-back-pain-medicare-beneficiaries
To read the final decision: https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=295
CPT Coding for Acupuncture: https://holisticbillingservices.com/blog/most-frequently-used-acupuncture-codes-for-insurance-billing