CMS to Cover New Chronic Lower Back Pain Therapy

In a national coverage determination reconsideration, the Centers for Medicare & Medicaid Services (CMS) announced recently the decision to cover acupuncture for Medicare enrollees diagnosed with chronic low back pain.

This decision comes after CMS conducted evidence reviews and reviewed private payer coverage policies, as well as a need to offer alternatives to opioids for pain management. Medicare enrollees will be offered coverage for up to 12 sessions in a 90-day period with potential for an additional eight sessions if improvement is demonstrated.

 “We are building on important lessons learned from the private sector in this critical aspect of patient care,” said CMS Principal Deputy Administrator of Operations and Policy Kimberly Brandt. “Over-reliance on opioids for people with chronic pain is one of the factors that led to the crisis, so it is vital that we offer a range of treatment options for our beneficiaries.”

The agency recognizes that while there are few studies analyzing the effectiveness of acupuncture in adults older than 65-years, the available results show function improvements and pain reduction. This data is the result of research conducted by CMS after its proposal to cover acupuncture last July.

CMS’ press release also stated, “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.”

“We are dedicated to increasing access to alternatives to prescription opioids and believe that covering acupuncture for chronic low back pain is in the best interest of Medicare patients,” said Ms Brandt.

“As with other complex diseases, CMS recognizes the importance of having treatment options which allow for an integrated approach that is tailored to the needs and preferences of Medicare patients,” concluded CMS’ press release.—Edan Stanley