Medicare to consider coverage of acupuncture for low back pain

by: Laura Evans, CPC Jan 15, 2019

In a move that appears to be prompted by the U.S. opioid addiction crisis, Medicare has launched a national coverage analysis for acupuncture to address chronic low back pain (CLBP).

If approved, acupuncture – long classified as non-covered by the Medicare program – could become a covered procedure by as soon as October.

CMS itself initiated the national coverage analysis “to complete a thorough review of the evidence to determine if acupuncture for CLBP is reasonable and necessary under the Medicare program.”

The initiative is part of an effort to prevent “opioid use disorder” by “providing more evidence-based non-pharmacological treatment options for chronic pain,” CMS states on the tracking sheet for national coverage analysis.

The agency is looking for public comment on whether acupuncture for CLBP is reasonable and necessary. In particular, CMS would like to know about scientific evidence that it is (or isn’t) effective, who are appropriate clinicians and what type of training is required. The agency is accepting comments through Feb. 14 on this issue. A proposed decision memo is due out by July 15 and the analysis should be completed by Oct. 13, CMS states.

Coincidentally, the AMA is also considering an overhaul of the acupuncture codes in the 2020 CPT manual.

Other federal agencies, including the National Institutes of Health and the Agency for Healthcare Research and Quality (AHRQ) are collaborating in the effort. AHRQ, for example, published a systematic review of noninvasive, nonpharmacological treatments for chronic pain. In addition, NIH has issued a Funding Opportunity Announcement to conduct a clinical trial to evaluate acupuncture treatment for older adults, including the impact and strategies to best implement such treatments.

Blog Tags: CMS

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