As of January 21, 2020, Medicare announced the coverage of acupuncture for beneficiaries. They came to the decision to cover acupuncture for chronic low back pain only. This news has been long awaited, and it did not disappoint. Research conducted to prove the benefits of acupuncture for chronic low back pain helped lead to a final decision on coverage.
There are a few requirements that patients must meet in order to have coverage for low back pain.
First, let’s look at how Medicare defines chronic low back pain:
- Lasting 12 weeks or longer
- Nonspecific – not associated with inflammatory, infectious disease – no identifiable systemic cause
- Not associated with surgery
- Not associated with pregnancy
Now, let’s look at the criteria for the coverage:
- Covers up to 12 visits in 90 days
- An additional 8 sessions will be covered for
beneficiaries demonstrating improvement
- No more than 20 acupuncture treatments may be
- Treatment must be discontinued if the patient is not improving or is regressing
Lastly, let’s look at the physician requirements/information to administer treatments according to Medicare:
- Must furnish acupuncture in accordance with applicable state requirements
- May administer acupuncture if you 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 of the United States or District of Columbia.
- The fee schedule will be between $50-$70
This coverage will take affect for visits on or after January 21, 2020, and it was done to give beneficiaries clinical strategies that include nonpharmacologic therapies for chronic low back pain. Being that opioids were involved in 47,600 deaths in 2017, CMS Principal Deputy Administrator of Operations and Policy stated “We are dedicated to increasing access to alternatives to prescription opioids and believe that covering acupuncture for chronic low back pain is in the best interest of Medicare patients.”
If you would like to read the full text on this coverage decision, please visit CMS.gov. This is a big day for acupuncture! Keep spreading the word and healing to all of your patients; it seems western medicine is taking notice, and we couldn’t be more thrilled!
*UPDATE: Please read the acupuncture coverage memo that came out yesterday in FULL as there are caveats listed toward the bottom clarifying as to who/how acupuncture can be performed according to Medicare. To give an idea of this, a part of the memo states “Currently, acupuncturists are not recognized by CMS as Medicare providers, and are not eligible to bill for acupuncture services. It is possible, however, for acupuncturists to provide acupuncture as auxiliary personnel ‘incident to’ a physician’s service in certain settings.”
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