CMS Finalizes Decision to Cover Acupuncture for Chronic Low Back Pain

CMS Finalizes Decision to Cover Acupuncture for Chronic Low Back Pain

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After conducting many reviews and examining the coverage policies of private payers, the Centers for Medicare and Medicaid Services (CMS) finalized a decision to cover acupuncture for Medicare patients that suffer from chronic low back pain. The increased reliance on opioids and the current opioid public health crisis were large contributors to this decision. Studies have shown that patients who have suffered from chronic low back pain, and were treated by acupuncture, showed significant improvements in both function and pain. Hence, a better alternative than prescription opioids. This expansion of options for pain treatment is a large piece of the Trump Administrations’ strategy for defeating the country’s opioid crisis.

Acupuncture is a treatment performed by practitioners who stimulate specific points on the body by inserting small thin needles through the skin. For the purpose of this decision, chronic low back pain 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.

Medicare will cover up to 12 sessions in 90 days, with an additional 8 sessions for those patients with chronic low back pain who demonstrate improvement. No more than 20 acupuncture treatments may be administered annually. Treatment must be discontinued if the patient is not improving or is regressing.

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