Insurance

Medicare to Cover Acupuncture for Chronic Low Back Pain

Insurance Update: Medicare to Cover Acupuncture for Chronic Low Back Pain

By Matt Minnella, Director of Insurance and Regulatory Affairs

CMS announced on Tuesday that Medicare will cover acupuncture for chronic low back pain for dates of service on or after Jan. 21, 2020.  In this case, chronic low back pain is defined as back pain that is:

• 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

At this time up to 12 visits will be covered within 90 days and up to an additional eight visits will be covered for patients demonstrating improvement.  No more than 20 acupuncture visits will be allowed annually.

We are currently researching this development to identify more details that are not immediately available such as allowed diagnosis codes, reimbursement rates, procedure coding, any required modifiers, etc.  We will update membership as more information is obtained.

For more information see the below links from CMS:

CMS Press Release

CMS National Coverage Determination on Acupuncture