Anesthesia & Pain Management Compliance Auditors

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26
Feb

CMS Covers Acupuncture

In a surprising announcement, CMS made a national decision summary that now allows for coverage for acupuncture as a treatment for chronic low back pain.  But before everyone gets all excited, it is important to read the fine print, as they say. 

The question is what qualifies for chronic low back pain and what must be documented:

Low back pain is defined as “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.”  Documentation is to include: “well described and realistic goals aimed to significantly improve the patient’s functional status over a reasonable and defined period.  Continuation of treatment is contingent upon progression towards treatment goals as evidenced by specific and significant objective (i.e. measurable) improvements of function and clinical findings (e.g., outcome assessment scales, range of motion) and treatment is discontinued it the patient is not improving or regressing.”

CMS will cover up to 12 visits in a 90-day period but does restrict that no more than 20 acupuncture treatments may be administered annually. 

Acupuncture has been a long-time accepted treatment for pain management.  Caution: this is only for chronic low back pain; any other condition is considered non-covered by Medicare.  You can read the press announcement at https://www.cms.gov/newsroom/press-releases/cms-finalizes-decision-cover-acupuncture-chronic-low-back-pain-medicare-beneficiaries which also has a link to the National Coverage Decision. 

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