CMS proposes acupuncture coverage for low back pain research

The Centers for Medicare and Medicaid Services (CMS) earlier this week proposed to cover acupuncture for Medicare patients with chronic low back pain who are enrolled participants either in clinical trials sponsored by the National Institutes of Health (NIH) or in CMS-approved studies, according to a statement released by the agency.

Chronic low back pain is defined as pain that persists for 12 weeks or longer, even after an initial injury or underlying cause of acute low back pain has been treated. About 20 percent of people affected by acute low back pain develop chronic low back pain, according to the American Pain Society.

Currently, acupuncture is not covered by Medicare, though injections, braces, implanted neurostimulators, and chiropractic care, as well as some prescription drugs, are covered for chronic low-back pain under certain conditions. CMS conducted reviews and says it recognizes the evidence base for acupuncture has grown in recent years. The studies will allow the government to examine where there is enough evidence to offer Medicare coverage.

As part of the Opioids Workgroup and Evidence Generation Workgroup, CMS has already been collaborating with the NIH to launch studies in acupuncture for treatment of low back pain in adults 65 years and old. Under the new proposal, CMS will continue to collaborate with the NIH further to develop evidence that will inform future Medicare coverage determinations for acupuncture treatment for beneficiaries with low back pain.

“Chronic low back pain impacts many Medicare patients and is a leading reason for opioid prescribing,” said Kimberly Brandt, principal deputy administrator of operations and policy for CMS, in the statement. “Today’s proposed decision 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. 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.”