January 23, 2020

CMS on Tuesday announced that Medicare will cover a maximum of 20 acupuncture sessions per year for beneficiaries with nonspecific, chronic lower back pain, providing pain patients an alternative to opioids.

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Background

Acupuncture involves a practitioner inserting thin needles into a patient's skin to simulate specific points of the body. In recent years, there's been a growing body of evidence that acupuncture could be used as a viable treatment for back pain. As such, CMS last year unveiledproposal to cover acupuncture in some cases, citing a growing need for alternative pain management treatments in light of the opioid epidemic.

Medicare announces decision to cover acupuncture treatments

On Tuesday, CMS announced Medicare will cover a maximum of 20 acupuncture sessions per year for beneficiaries with chronic lower back pain.

CMS for the decision defined chronic lower back pain as pain that lasts 12 weeks or longer, has no identifiable systemic cause, and is not associated with surgery or pregnancy.

Medicare under the decision will cover up to 12 acupuncture sessions in 90 days for qualifying beneficiaries and will cover an additional eight sessions for qualifying beneficiaries who demonstrate improvement after the acupuncture treatments. However, CMS said treatments will be discontinued if the patient is not improving.

CMS said it reached the decision to cover the treatment after reviewing scientific evidence of its efficacy and coverage policies.

Comments

HHS Secretary Alex Azar said offering alternative treatments for pain management "is a key piece of the Trump administration's strategy for defeating our country's opioid crisis." According to CMS, up to 66% of patients with chronic lower back pain are prescribed opioids.

"Over-reliance on opioids for people with chronic pain is one of the factors that led to the crisis, so it is vital that we offer a range of treatment options for our beneficiaries," CMS Principal Deputy Administrator of Operations and Policy Kimberly Brandt said in a news release (Ellison, Becker's Hospital CFO Report, 1/21; Brady, Modern Healthcare, 1/21; CMS decision memo, accessed 1/22).

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