CHANGES ON MEDICARE COVERAGE OF ACUPUNCTURE FOR CHRONIC LOWER BACK PAIN

3/13/2020

CHANGES ON MEDICARE COVERAGE OF ACUPUNCTURE FOR CHRONIC LOWER BACK PAIN


Previously, the Centers for Medicare & Medicare Services did not cover acupuncture in their list of reimbursable medical procedures. After opening a national coverage determination (NCD) analysis to complete a thorough review, they found evidence supporting the view that acupuncture can be an effective treatment for back pain.

On January 21, 2020, the Centers for Medicare & Medicaid Services (CMS) published a final Decision Memo regarding Acupuncture as a treatment for Chronic Low Back Pain. They will cover acupuncture for chronic low back pain under section 1862(a)(1)(A) of the Social Security Act. Here are some details you should know about this new coverage:

• Up to 12 visits in 90 days will be covered for Medicare beneficiaries under the following circumstances:

For the purpose of this decision, chronic low back pain (cLBP) is defined as
  • Lasting 12 weeks or longer;
  • nonspecific, in that it has no identifiable systemic cause (i.e., not associated with metastatic, inflammatory, infectious, etc. disease)
  • not associated with surgery, and
  • not associated with pregnancy.
• An additional eight sessions will be covered for patients demonstrating an improvement.
• No more than 20 acupuncture treatments may be administered annually.
• Treatment must be discontinued if the patient is not improving or is regressing.

Physicians (as defined in 1861(r)(1)) may practice acupuncture per applicable state requirements. Physician assistants, nurse practitioners/clinical nurse specialists (as identified in 1861(aa)(5)), and auxiliary personnel may also perform acupuncture if they meet all applicable state requirements and have:
  • A masters or doctoral-level degree in acupuncture or Oriental Medicine from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine (ACAOM); and
  • have a current, full, active, and unrestricted license to practice acupuncture in a State, Territory, or Commonwealth (i.e. Puerto Rico) of the United States, or District of Columbia.

Auxiliary personnel practicing acupuncture must be under the appropriate level of supervision of a physician, physician assistant, or nurse practitioner/clinical nurse specialist required by regulations 42 CFR §§ 410.26 and 410.27.

It should be noted that Medicare will not cover acupuncture for any other conditions except for chronic lower back pain.
Although the final decision memo was published, there is no effective date available yet, keep up with our newsletter for further information.

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