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CMS plunges in, releases proposed acupuncture national coverage decision

It’s official: Medicare released a proposal July 15 to cover acupuncture as a remedy for chronic low back pain.
The patient must be enrolled in a CMS-approved clinical study and have been suffering from chronic low back pain (cLBP) for a minimum of 12 weeks with no identifiable systemic cause – that is, the pain is not associated with metastatic, inflammatory or infectious disease, surgery or pregnancy.
CMS proposes that approved clinical trials provide a minimum 12-week acupuncture program “versus usual care or other intervention for chronic low back pain.”
Approved studies would have to try to answer one or both of these questions:
  • “Does the use of acupuncture for the treatment of cLBP decrease pain and/or increase function?
  • “Does the use of acupuncture for the treatment of cLBP decrease the use of other continuing medical treatments and services (e.g. opioids)?”
The studies may be randomized controlled trials, observational trials or registries, but they wouldn’t be limited to those, CMS states.
Physicians may personally provide the acupuncture treatments the therapy may be provided by non-physician practitioners or “auxiliary personnel” who 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);
  • “A current certification by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM); and
  • “Maintained licensure in a U.S. state or territory to practice acupuncture.”
Any auxiliary personnel providing acupuncture will need to be under direct supervision of the physician or physician assistant, nurse practitioner or clinical nurse specialist, the agency states. Translation: The supervising clinician must be present in the office suite to provide assistance as needed.
Acupuncture has been a non-covered service by Medicare for decades. This new coverage initiative is part of an effort by CMS to identify non-pharmacological alternatives to opioids to combat the common complaint of chronic low back pain. The agency could issue a final coverage memo by as early as October, according to its initial coverage analysis.
CMS is seeking comment on the proposed national coverage decision. More than 750 commenters responded to the agency’s January national coverage analysis, with “the vast majority” in support of Medicare acupuncture coverage, according to CMS.  
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