Today, the Centers for Medicare & Medicaid Services (CMS) finalized a decision to cover acupuncture for Medicare patients with chronic low back pain, specifically related to the medical code M54.51. Before this final National Coverage Determination (NCD) reconsideration, acupuncture was not covered by Medicare. CMS conducted evidence reviews and examined the coverage policies of private payers to inform this decision.

The decision regarding coverage takes into account 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 (M54.51 medical code) 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 too that while there is variation in covered indications and frequency of services, a number of large private payers provide some coverage of acupuncture for certain indications.

Holistic Billing is monitoring this as news develops. Stay tuned for additional updates.

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