Insurance

02/11/2020

Medicare Acupuncture Update

We had previously advised membership that Medicare had begun covering acupuncture in certain specified situations as of Jan. 21, 2020.  Acupuncture is to be allowed for chronic low back pain for 12 visits with an additional eight if improvement is shown, with no more than 20 visits allowed annually.

To date, Medicare has provided only a press release and a “Decision Memo” regarding the new acupuncture coverage.  This has left many questions regarding who can perform the services, what diagnosis codes will be considered “chronic low back pain” and allowed, what the reimbursement rates will be, documentation requirements, etc. 

We have thoroughly reviewed the available documents, spoken with the ACA, reached out to industry experts throughout the country and inquired with our local Medicare Administrative Contractor (MAC) Novitas in our attempts to answer these questions. 

The Decision Memo gives direction on who can perform the services.  It states that physicians (as defined by Sec.1861(r)(1) of the Social Security Act) can perform the services if they meet all applicable state requirements. The memo also states that  physician assistants, nurse practitioners/clinical nurse specialists (as defined by Sec.1861(aa)(5) of the Social Security Act) and auxiliary personnel can perform the services if they have a masters or doctor level degree in acupuncture or Oriental Medicine from a school accredited by the ACAOM and are actively licensed to practice acupuncture in their state.  Per the definitions of physician referenced, only doctors of medicine or osteopathy are included.  Also, while a PA, NP or CNS can perform the services if they are also licensed as an acupuncturist, by the definitions given for “auxiliary personnel” it is not clear if a licensed acupuncturist who is not a PA/NP/CNS can perform these services, even under the supervision of an MD or DO. 

Our local MAC, Novitas, has advised that CMS has not yet provided any information beyond the Decision Memo with regards to what diagnosis codes or CPT codes will be included in this coverage.  They advise that CMS does intend to establish a National Coverage Determination (NCD) for these services but has not provided a timeline for this. 

We will continue to monitor this situation and report to members as soon as any additional information is confirmed. 

CMS Press Release
CMS National Coverage Determination on Acupuncture