CMS May Cover Acupuncture as Opioid Alternative for Chronic Back Pain

Deborah Brauser

July 17, 2019

The Centers for Medicare & Medicaid Services (CMS) may cover acupuncture for chronic low back pain in patients who are both Medicare beneficiaries and enrolled in approved studies.

In a 43-page proposal, the CMS discusses coverage options for participants in acupuncture trials that the organization approves of and/or are sponsored by the National Institutes of Health (NIH).

The agency "recognizes that the evidence base for acupuncture has grown in recent years, but questions remain," the CMS said in a press release.

Still, "defeating our country's epidemic of opioid addiction requires identifying all possible ways to treat the very real problem of pain, and this proposal would provide patients with new options while expanding our scientific understanding of alternative approaches to pain," Alex Azar, secretary of Health & Human Services, noted in the same release.

Opioid Alternative

As members of the Opioids and Evidence Generation Workgroups, CMS and the NIH have been working together to create acupuncture studies in adults older than 64 years who have chronic low back pain.

The new CMS proposal notes that, for a Medicare beneficiary with this condition to be covered, they must be enrolled in a study that meets several criteria, including that chronic low back pain is defined as lasting at least 12 weeks, is not associated with surgery within 12 weeks of study enrollment, and has no "identifiable systemic cause."

In addition, the study must include acupuncture versus usual care or other treatment design that lasts at least 12 weeks, and endpoints need to be measured at 12 weeks, 6 months, and 12 months.

Although acupuncture isn't currently covered by Medicare, it has been cited before as a possible alternative to opioids.

In addition, as reported by Medscape Medical News, a presentation in 2017 at the Academy of Integrative Pain Management annual meeting noted that "unprecedented advances" had occurred in acupuncture use for pain conditions during the preceding two decades and that there's been a "rapid rise" in the number and quality of related published studies.

Although new research is being conducted, the CMS notes coverage could significantly benefit study participants with chronic low back pain.

The proposed decision "would provide Medicare patients...with access to a nonpharmacologic treatment option and could help reduce reliance on prescription opioids," said Kimberly Brandt, principal deputy administrator of operations at the CMS.

The agency proposes to cover acupuncture under section 1862(a)(1)(E) of the Social Security Act.

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