Medicare Opts to Cover Acupuncture for Pain Amid Opioid Crisis

Kerry Dooley Young

January 29, 2020

Medicare this month said it would cover acupuncture for people with chronic low back pain, seeking to give patients alternatives to potentially addictive narcotic painkillers.

The Centers for Medicare and Medicaid Services (CMS) on January 21 announced a national coverage determination for this treatment. For purposes of coverage, people need to have had chronic low back pain that has persisted for at least 12 weeks or longer, the agency said. This pain must have no identifiable cause, such as infections, disease, surgery, and pregnancy. 

Under these circumstances, CMS will cover as many as 12 visits in 90 days. The agency said it will cover an additional eight sessions for those patients demonstrating an improvement. There is a limit of 20 covered acupuncture treatments a year. Treatment should be discontinued if patients don't show improvement, CMS said.

"We are building on important lessons learned from the private sector in this critical aspect of patient care," CMS Principal Deputy Administrator of Operations and Policy Kimberly Brandt said in the announcement. "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."

In the decision memo, CMS said that insurers including Aetna, various Blue Cross Blue Shield plans, Cigna, Kaiser Permanente, and United Healthcare provide some coverage of acupuncture. The agency said that the relative safety of acupuncture and the grave consequences of the opioid crisis in the United States provided "sufficient rationale to provide this nonpharmacologic treatment" to people enrolled in Medicare who have chronic low back pain. 

"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 in these studies showed improvements in function and pain," CMS said.

Back-and-Forth Issue

In the decision memo, CMS said it had mulled and then in 1980 rejected the idea of covering acupuncture. In 2004, CMS considered acupuncture for fibromyalgia but found no convincing evidence for this benefit. In that same year, CMS also drew the same conclusion about the use of acupuncture for pain relief in patients with osteoarthritis.

CMS also noted in the memo that many groups and individuals had written to the agency in support of Medicare coverage of acupuncture, with patients often including personal reports of pain relief.

But a few commenters told CMS that acupuncture was a "pseudoscience," with positive results described in some report likely due to the placebo effect.

Among the critics of the proposal was Steven L. Salzberg, PhD, director of the Center for Computational Biology at Johns Hopkins University School of Medicine. He told CMS he was concerned about the use of taxpayers' money to cover acupuncture.

"No well-designed study has ever shown that it has any benefit beyond a placebo effect, and scientifically there is no serious debate about its efficacy," Salzberg said in his comment submitted to CMS in January 2019. "Simply put, it does not work, and patients who believe in acupuncture are being misled. Testimonials such as those in the comments here do not comprise evidence."

Salzberg confirmed for Medscape Medical News on Tuesday that this remains his view.

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