One of the most common questions we receive here at MSA Meds is whether or not acupuncture is covered under a client’s MSA. In the past, the answer has been no; however, CMS has recently begun to reconsider this as a viable treatment option. On 1/15/2019, the Centers for Medicare & Medicaid Services (CMS) opened a National Coverage Analysis (NCA) to thoroughly assess empirical evidence showing that acupuncture for low back pain is reasonable and necessary under the Medicare program. The public comment period is open until 2/14/19, a proposed decision memo due date is set for 7/15/19, and the expected NCA completion date is 10/13/19. The NCA tracking sheet can be found here: (https://www.cms.gov/medicare-coverage-database/details/nca-tracking-sheet.aspx?NCAId=295).
To curtail opioid misuse, HHS is focused on providing more evidence-based non-pharmacologic treatment options for chronic pain. So, if Medicare coverage of acupuncture for chronic low back pain is approved, how will this impact future Medicare Set-Asides (MSAs)? Oftentimes, cases involving injuries to the lumbar spine leave claimants with little recourse for relieving lifelong chronic low back pain. Not only can acupuncture be used in conjunction with other conservative measures, including physical therapy, anti-inflammatory medications, and bracing but it is also relatively inexpensive, with costs similar to physical therapy. To conclude, Medicare coverage of acupuncture may be a very reasonable and cost-effective treatment alternative for alleviating pain for injured workers.
