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July 18, 2019

Medicare proposes covering acupuncture for lower back pain in clinical trials

Daily Briefing

    CMS on Monday announced a proposal to cover acupuncture for Medicare beneficiaries with chronic low-back pain who are enrolled in NIH-sponsored or CMS-approved clinical trials that are evaluating acupuncture as an alternative treatment to opioids.

    How to help patients better manage chronic pain to reduce chronic utilization

    Acupuncture involves a practitioner inserting thin needles into a patient's skin to simulate specific points of the body. CMS currently does not cover acupuncture. However, CMS in a release acknowledged a growing body of evidence to support the use of acupuncture as a treatment for back pain, though the agency noted several questions—including whether acupuncture effectively treats pain among older adults—remain.

    Proposal details

    CMS said the proposal is part of its ongoing collaboration with NIH under the Opioids Workgroup and Evidence Generation Workgroup. The proposals seeks to gather new evidence to inform future coverage decisions for acupuncture treatment, the agency said. CMS said the proposal will help the agency to evaluate whether acupuncture is an effective treatment for chronic lower back pain among Medicare beneficiaries who are at least age 65.

    Under the proposal, CMS will cover acupuncture for beneficiaries who are enrolled in an NIH-sponsored or CMS-approved clinical trial designed to assess acupuncture's effectiveness among older adults.

     CMS is accepting public comments on the proposal, as well as comments regarding whether there is evidence to support extending acupuncture coverage to more Medicare beneficiaries, until Aug. 14.


    HHS Secretary Alex Azar said the "proposal represents the Trump administration's commitment to providing Americans with access to a wide array of options to support their health. Defeating our country's epidemic of opioid addiction requires identifying all possible ways to treat the very real problem of chronic pain, and this proposal would provide patients with new options while expanding our scientific understanding of alternative approaches to pain."

    Kimberly Brandt, principal deputy administrator of operations and policy at CMS, said, "Chronic low back pain impacts many Medicare patients and is a leading reason for opioid prescribing."

    Brandt said the proposal "would provide Medicare patients who suffer from chronic low back pain with access to a nonpharmacologic treatment option and could help reduce reliance on prescription opioids." She added, "CMS will work closely with our sister agencies to monitor outcomes for Medicare beneficiaries receiving acupuncture to inform our understanding of the efficacy of this therapeutic approach" (CMS release, 7/15; Castellucci, "Transformation Hub," Modern Healthcare, 7/15; Bernstein, Washington Post, 7/15; Diamond, "Pulse," Politico, 7/16; Romoser, Inside Health Policy, 7/15 [subscription required]; National Coverage Analysis Tracking Sheet for Acupuncture for Chronic Low Back Pain, 7/15; Proposed Decision Memo for Acupuncture for Chronic Low Back Pain, 7/15).

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