Does Medicare Cover Acupuncture for Back Pain?

Medicare coverage acupuncture for back pain

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Contrary to what many people believe, Medicare does not cover everything you need. That often leaves you to pay for alternative and complementary treatments, like acupuncture, out of your own pocket. With the rise of the opioid epidemic, however, the Centers for Medicare and Medicaid Services (CMS) is looking to find new ways to treat chronic pain syndromes. To that end, Medicare is now looking to add acupuncture as a covered benefit.

Alternatives to Opioid Medications

The Centers for Disease Control and Prevention (CDC) estimated that as many as 20% of American adults suffered from chronic pain in 2016. More than 6.6 million of those adults were on some sort of Medicare (Original Medicare or Medicare Advantage), with or without Medicaid.

The default treatment for pain is medication. Unfortunately, this has led to an increase in opioid drug prescriptions over the years. While these medications are appropriate in some cases, they increase the risk of addiction and abuse in others. Between 1999 and 2017, more than 700,000 Americans died from an opioid overdose. According to the CDC, 130 people die from an overdose every day. Finding alternatives to opioid medications may be the best way to stem the rising opioid epidemic.

When it comes to back pain, Medicare covers prescription medication and, in appropriate cases, epidural injections. Depending on the diagnostic codes your doctor uses, Medicare may also cover physical therapy, implanted neurostimulators, and even chiropractic care (manual manipulation of the spine). Keep in mind, however, that Medicare will not pay for any services or tests ordered by a chiropractor. What is left out of the mix is massage therapy and acupuncture. That may be about to change.

Acupuncture for Back Pain

Medicare aims to cover treatments that are medically necessary, and acupuncture remains a controversial procedure. Acupuncture is an ancient Chinese practice where small needles are inserted into the skin to stimulate responses in certain areas of the body. The exact mechanism for how it works is unknown, though it is theorized that neurohormonal pathways may play a part.

To date, acupuncture has been used to treat a number of conditions including allergic rhinitis, asthma, chronic fatigue syndrome, depression, fibromyalgia, glaucoma, hypertension, infertility, lupus, migraine headaches, nausea, and numerous pain syndromes ranging from low back pain to rheumatoid arthritis.

While some studies show acupuncture has clinical benefits, others have shown that it is not necessarily more effective than other treatments or even no treatment at all. This is where "sham acupuncture" comes in handy. Researchers use this technique to simulate acupuncture without actually puncturing the skin. Because acupuncture needles are generally painless, someone treated with sham acupuncture will not be able to tell if they received the treatment or not. This helps to remove concerns about a placebo effect in clinical studies.

A randomized clinical trial in the Archives of Internal Medicine compared acupuncture with sham acupuncture or usual care (e.g., medications including non-steroidal anti-inflammatory drugs like ibuprofen and naproxen) in 638 adults with chronic back pain over seven weeks of treatment. Overall, traditional and sham acupuncture performed comparably well but significantly better than usual care. Specifically, after eight weeks, dysfunction in the acupuncture groups was decreased by 60% but only by 39% in the usual care group. After one year, the results were less pronounced but the acupuncture groups had a 59% to 65% decrease in dysfunction versus 50% in the usual treatment group.

Likewise, a 2018 meta-analysis in The Journal of Pain reviewed the results of 39 studies across nearly 21,000 patients for people with chronic pain (head, knee, low back, neck, and/or shoulder), concluding that “acupuncture was superior to sham as well as no acupuncture control for each pain condition.”

Acupuncture for chronic back pain is recommended by the American College of Physicians (ACP), the National Institutes of Health (NIH), and the U.S. Agency for Healthcare Research and Quality (AHRQ). With medical organizations like these in favor of acupuncture, Medicare is now considering coverage for the service.

Medicare Coverage for Acupuncture

In July 2019, CMS proposed a new rule that will allow acupuncture to be covered for people with chronic back pain when they enroll in Medicare-approved clinical trials. To be eligible, study participants have to have had back pain for at least 12 months and that back pain cannot be attributable to another medical condition or to surgery within the past 12 months. Pregnancy also disqualifies someone from participating.

To be considered for inclusion as a clinical trial, acupuncture must be performed by a physician, a physician assistant, a nurse practitioner, a clinical nurse specialist, or auxiliary personnel (only if supervised by one of the other provider types) that has a masters or doctoral degree in acupuncture from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine. They must also be currently certified by the National Certification Commission for Acupuncture and Oriental Medicine and have a license in the state or U.S. territory where they perform acupuncture.

The planned treatment course must be at least 12 months in duration with frequent check-ups. Of course, the clinical trials have to adhere to certain standards for design, ethics, and safety. When clinical studies have been approved, they will be posted on the CMS website.

Clinical trials like these may give people hope that acupuncture may one day be covered as a regular Medicare benefit. For now, this is at least a step in the right direction.

A Word from Verywell

Living with chronic back pain is not always easy. It can impair your ability to perform activities of daily living and can decrease your overall quality of life. Medicare is taking note. In an attempt to decrease overuse of opioid medications and the complications that come with them, alternative pain modalities are being considered. That includes acupuncture. Although acupuncture is not yet approved as a regular Medicare benefit, clinical trials are being pursued by CMS to investigate how effective the treatment really is.

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Article Sources

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  2. Opioid Overdose: Understanding the Epidemic. Centers for Disease Control and Prevention. Updated December 19, 2018.

  3. Cherkin DC, Sherman KJ, Avins AL et al. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Arch Intern Med. 2009;169(9):858. doi:10.1001/archinternmed.2009.65

  4. Vickers AJ, Vertosick EA, Lewith G, et al. Acupuncture for chronic pain: update of an individual patient data meta-analysisJ Pain. 2018; 19(5):455–474. doi:10.1016/j.jpain.2017.11.005

  5. Qaseem A, Wilt TJ, McLean RM, Forciea M. Clinical Guidelines Committee of the American College of Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017; 166(7):514–530. doi:10.7326/M16-2367

  6. Proposed Decision Memo for Acupuncture for Chronic Low Back Pain (CAG-00452N). Centers for Medicare and Medicaid Services. Published July 15, 2019.

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