Question: Is it true that Medicare now covers for acupuncture?
No, that is erroneous, but the notion is based on information about Medicare looking to acupuncture as a potential covered treatment for chronic lower back pain. Medicare does not cover acupuncture delivered by any provider and also does not credential acupuncturists.
An Encouraging Proposal
In mid-summer of this year, the Trump administration proposed a plan to cover acupuncture for Medicare patients with chronic low back pain, framing it as a step that could safely treat pain without supplying more patients with opioids.
"Defeating our country's epidemic of opioid addiction requires identifying all possible ways to treat the very real problem of chronic pain, and this proposal would provide patients with new options while expanding our scientific understanding of alternative approaches to pain," Health Secretary Alex Azar said in a statement.1
The proposal, released by the Centers for Medicare and Medicaid Services, would apply only to patients enrolled in clinical trials supported by the National Institutes of Health or those approved by CMS. In its statement, CMS acknowledged that while "the evidence base for acupuncture has grown in recent years ... questions remain."
Some experts argue the benefits of acupuncture are nothing more than the placebo effect and the enjoyment of a ritual – results that do not merit coverage paid for by taxpayers.
Some medical groups, however, have recommended acupuncture for chronic low back pain, especially as clinicians try to resolve chronic pain issues without starting new patients on opioids. In 2017, for example, the American College of Physicians recommended that clinicians should first try therapies other than drugs for chronic low back pain, including exercise, yoga and acupuncture.
"Chronic low back pain impacts many Medicare patients and is a leading reason for opioid prescribing," said CMS Principal Deputy Administrator of Operations and Policy, Kimberly Brandt. "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."1
The Need Isn't Going Away
This is a very positive step for acupuncture providers to gain access to Medicare. Of course, Medicare is a national insurance that virtually all American workers pay into and receive as a benefit at age 65. There are currently 57 million Medicare enrollees. By 2030, all baby boomers will be of Medicare age: one in five Americans. What's more, by 2035 more Americans will be over the age of 65 than age 18.
Medicare participants also represent a patient base prone to chronic pain issues. Certainly utilization of acupuncture would likely generate positive outcomes with reduced medical costs, not to mention avoiding the use of opioids.
To date, information from individuals with direct knowledge suggests there appears to be a positive track to move forward with the study.2
A State Precedent?
Note that in the state of Washington, there were traditionally no benefits for acupuncture in workers' compensation. However, there was a pilot project undertaken in October 2017 to ascertain the efficacy of acupuncture and lower back pain. The study utilized the requirement of outcome assessment tools and functional change as a result of the acupuncture intervention. The study was to be for two years, but by May 31, 2019, it was decided to include acupuncture benefits for workers' compensation in Washington state for the treatment of lower back pain.
Clearly, this inclusion on the state level demonstrates the benefits of acupuncture for lower back pain, and the fact that Medicare is looking to do the same is promising. One area that I believe will need to be addressed by the profession, however, is a national certification, as it is a typical Medicare requirement that providers must have some universal or national certification.
How It Works Right Now
If you currently treat Medicare patients, they are 100 percent cash or self-pay unless they have some additional insurance beyond Medicare. However, the good news is that some Medicare Advantage plans or Medicare part C do have acupuncture benefits, and many traditional Medicare patients have traded their benefits for these plans. The plans offer at least 12 visits per year and some offer unlimited visits based on medical necessity.
References
- "CMS Proposes to cover Acupuncture for Chronic Low Back Pain for Medicare Beneficiaries Enrolled in Approved Studies." CMS Press release, July 15, 2019.
- National Coverage Analysis (NCA) Tracking Sheet for Acupuncture for Chronic Low Back Pain (CAG-00452N). Centers for Medicare & Medicaid Services.
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