CMS finalizes decision to cover acupuncture for low back pain

On Tuesday, the Centers for Medicare and Medicaid Services (CMS) finalized a decision to cover acupuncture for Medicare patients with chronic low back pain, according to a summary released by the agency.

In July, the agency proposed to cover acupuncture for Medicare patients with chronic low back pain who were enrolled participants either in clinical trials sponsored by the National Institutes of Health (NIH) or in CMS-approved studies.

After conducting evidence reviews and examining coverage policies of private payers, CMS decided it would cover a maximum of 20 acupuncture sessions per year for beneficiaries with nonspecific, chronic lower back pain, providing pain patients with an alternative to opioids.

The agency defines low back pain as pain that lasts 12 weeks or longer, has no identifiable systemic cause, and is not associated with surgery or pregnancy. Under the decision, Medicare 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.

According to CMS, the decision considers an assessment of benefits and harms and the opioid public health crisis.  While a small number of adults 65 years of age or older have been enrolled in published acupuncture studies, patients with chronic low back pain in these studies showed improvements in function and pain. The evidence reviewed for this decision supports clinical strategies that include nonpharmacologic therapies for chronic low back pain.

CMS notes that while there is variation in covered indications and frequency of services, several large private payers provide some coverage of acupuncture for certain indications.  

In 2017, opioids were involved in 47,600 deaths related to overdose, according to the Centers for Disease Control and Prevention. The integrative healthcare community has long called for nonpharmacologic treatments for low back pain and this decision is an exciting step.