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Acupuncture for Chronic Low Back Pain to be covered by Medicare for dates of service on and after January 21, 2020


CMS published Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) – to be implemented in April 2020.

With the changes, the below Acupuncture codes have been assigned the status code indicator “A = Active code,” which means “These codes are separately paid under the Medicare physician fee schedule, if covered.”

The changes to be implemented in April 2020, effective for dates of service on and after January 21, 2020.


20560 - Needle insertion(s) without injection(s); 1 or 2 muscle(s)

20561 - Needle insertion(s) without injection(s); 3 or more muscles

97810 - Acupuncture, 1 or more needles; without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient

97811 - Acupuncture, 1 or more needles; without electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (List separately in addition to code for primary procedure)

97813- Acupuncture, 1 or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient

97814 - Acupuncture, 1 or more needles; with electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (List separately in addition to code for primary procedure)

The fees will differ based on the locality and specific code. The approximate fee range is $30-$50.


Who may furnish the acupuncture for chronic low back pain?

Physicians (as defined in 1861(r)(1)) may furnish acupuncture in accordance with applicable state requirements.

Physician assistants, nurse practitioners/clinical nurse specialists (as identified in 1861(aa)(5)), and auxiliary personnel may furnish acupuncture if they meet all applicable state requirements and have:

  •  A masters or doctoral level degree in acupuncture or Oriental Medicine from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine (ACAOM); and
  •  current, full, active, and unrestricted license to practice acupuncture in a State, Territory, or Commonwealth (i.e. Puerto Rico) of the United States, or District of Columbia.

Auxiliary personnel furnishing acupuncture must be under the appropriate level of supervision of a physician, physician assistant, or nurse practitioner/clinical nurse specialist required by our regulations at 42 CFR §§ 410.26 and 410.27.

 

Within the Comment Period, several commenters requested that CMS remove the term “auxiliary personnel” from the final decision, and instead refer to these providers specifically as “licensed acupuncturists.” Most of these commenters also suggested editing the “direct supervision” requirement to only allow physicians to provide supervision, stating that physician assistants, nurse practitioners/clinical nurse specialists would not be qualified to supervise licensed acupuncturists.

 

CMS Response: Currently, acupuncturists are not recognized by CMS as Medicare providers, and are not eligible to bill for acupuncture services. It is possible, however, for acupuncturists to provide acupuncture as auxiliary personnel “incident to” a physician’s service in certain settings. The incident to regulations requires supervision by a physician or other practitioner. For further details regarding “incident to” services, we recommend that interested parties consult 42 CFR §§ 410.26 and 410.27. We are not able to amend these regulations through the national coverage determination process, however, we will change the specifc reference to “direct supervision” and will substitute “the appropriate level of supervision required by our regulations at 42 CFR §§ 410.26 and 410.27.”

 

One commenter requested chiropractic doctors who have completed the 100-hour acupuncture course and examination approved by the American Chiropractic Association (ACA) and the National Board of Chiropractic Examiners (NBCE) be included in the list of personnel able to furnish acupuncture in the studies.

 

CMS Response: CMS notes that the requirements for chiropractic acupuncturists vary widely from state to state. CMS also notes Medicare covers manual manipulation of the spine if medically necessary to correct a subluxation when provided by a chiropractor (or other qualified provider). Medicare does not cover other services or tests ordered by a chiropractor, including acupuncture. However, if a chiropractor fulfills the requirements in section I of the decision memo as auxiliary personnel, they would be eligible to furnish acupuncture “incident to” a physician’s service.

 

A reminder! According to the Decision Memo “All types of acupuncture, including dry needling for any condition other than chronic low back pain (cLBP) are non-covered by Medicare. “ 

Insights
February 2020