Medicare Compliance & Reimbursement

Coverage:

DON'T COUNT ON COVERAGE FOR ACUPUNCTURE

CMS nixes requests to cover acupuncture for osteoarthritis, fibromayalgia.  Health care practitioners shouldn't expect Medicare to cover acupuncture for osteoarthritis or fibromyalgia anytime soon. In a pair of recent decision memoranda (CAG-00174N and CAG-00175N), the Centers for Medicare & Medicaid Services' Coverage and Analysis Group decided that there wasn't enough evidence to conclude that acupuncture is reasonable and necessary for those conditions. As a result, CMS will continue its existing noncoverage policy for acupuncture. "While acupuncture may play an adjunctive role to medications for the treatment of pain," CMS says in its memo on osteoarthritis, "data from existing [randomized controlled trials] does not conclusively support that real acupuncture is superior to sham acupuncture for the pain associated with osteoarthritis." In both memos, CMS says design flaws in existing studies make them too unreliable to form a basis for coverage. The requests for coverage review in both instances came from Leesburg, FL Medicare beneficiary Jay Silverman. To see the osteoarthritis memo, go to http://cms.hhs.gov/mcd/viewdecisionmemo.asp?id=84. To see the fibromyalgia memo, go to http://cms.hhs.gov/mcd/viewdecisionmemo.asp?id=83.
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