Acupuncture for Chronic Low Back Pain – Is Medicare Coverage Reasonable and Necessary?

CMS, Medicare Set-Asides, Opioids on January 24, 2019
Posted by Jennifer J. Mislanovich, JD

On 01/15/19, the Centers for Medicare & Medicaid Services (CMS) opened a National Coverage Analysis (NCA) to complete a thorough review of the evidence to determine if acupuncture for chronic low back pain is reasonable and necessary under the Medicare program. The public comment period is open until 02/14/19, a proposed decision memo due date is set for 07/15/19, and the expected NCA completion date is 10/13/19. Please see the tracking NCA Tracking Sheet (CAG-00452N) here. In a period where opioid overdose is a grave national concern[1] the aim to find non-opioid treatment options for chronic pain has never been more pressing.  As this NCA demonstrates, acupuncture is being considered as such an option for patients as a non-invasive, non-medicated treatment modality, and an option with a relatively low cost.  Acupuncture can also be used hand-in-hand with other conservative measures, including physical therapy, anti-inflammatory medications, and bracing.

This sparks the question, if we see Medicare coverage of acupuncture for chronic low back pain in the future, how will this impact Medicare Set-Asides (MSAs)? In many claims involving the lumbar spine, the Claimant is often left with lifelong chronic low back pain; and acupuncture may be a modality that will relieve this chronic pain. Therefore, if Medicare begins to cover this treatment option, we will see acupuncture included in MSAs.  The good news is that acupuncture is relatively inexpensive, with costs similar to physical therapy.  While it is true that the value of MSAs will increase if acupuncture becomes a Medicare covered expense, we are hopeful that as physicians continue to reassess the need for chronic opioid medications for chronic pain, the overall value of MSAs will decrease if less opioids are prescribed for long-term use, and acupuncture is included as a viable chronic pain treatment option. Certainly, the benefits of inclusion of acupuncture versus opioids will be invaluable, particularly to injured workers.  In sum, Medicare coverage of acupuncture may be an impactful and reasonable treatment option in tackling the opioid crisis, and perhaps a very necessary treatment option for relieving pain for injured workers.  We will be sure to keep you updated on any advancements or findings of the NCA.

[1] Please see our series on the Opioid Crisis, particularly, The Opioid Crisis: What is the Government Doing About It? Part 3 – The Promotion of Healthy, Evidence-Based Methods of Pain Management,