Wiki NCD for acupuncture

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nlbarnes

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Hello - I have found a list of the covered dx for acupuncture but I think it's outdated. I have a hard time finding info within the NCD CMS (difficulty navigating).

Can someone please provide a link for the ICD-10 codes vs the NCD.
 
nlbarnes said:
Hello - I have found a list of the covered dx for acupuncture but I think it's outdated. I have a hard time finding info within the NCD CMS (difficulty navigating).

Can someone please provide a link for the ICD-10 codes vs the NCD.
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Indications and Limitations of Coverage


B. Nationally Covered Indications
Effective for claims with dates of service on and after January 21, 2020, acupuncture is only covered for chronic low back pain under section 1862(a)(1)(A) of the Social Security Act (the Act). See National Coverage Determination section 30.3.3 for specific coverage criteria.
C. Nationally Non-Covered Indications
Medicare reimbursement for acupuncture, as an anesthetic, or as an analgesic or for other therapeutic purposes, may not be made unless the specific indication is excepted. All indications for acupuncture outside of NCD section 30.3.3 remain non-covered.
 
sls314 said:

Indications and Limitations of Coverage


B. Nationally Covered Indications
Effective for claims with dates of service on and after January 21, 2020, acupuncture is only covered for chronic low back pain under section 1862(a)(1)(A) of the Social Security Act (the Act). See National Coverage Determination section 30.3.3 for specific coverage criteria.
C. Nationally Non-Covered Indications
Medicare reimbursement for acupuncture, as an anesthetic, or as an analgesic or for other therapeutic purposes, may not be made unless the specific indication is excepted. All indications for acupuncture outside of NCD section 30.3.3 remain non-covered.
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Hi there - acupuncture has been covered for more than chronic low back pain. I had a list/link but can't find it. The NCD states it might not be an exhaustive list. The links that you have kindly provided do not have ICD-10 codes. Since the updates in October 2024, that list has changed, Any other ideas please?
 
nlbarnes said:
Hi there - acupuncture has been covered for more than chronic low back pain. I had a list/link but can't find it. The NCD states it might not be an exhaustive list. The links that you have kindly provided do not have ICD-10 codes. Since the updates in October 2024, that list has changed, Any other ideas please?
Click to expand...

The Medicare website still states that Medicare only covers accupuncture for chronic low back pain, and not for any other condition.



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There are 4 NCDs related to Acupuncture:
30.3 Acupuncture
30.3.1 Acupuncture For Fibromyalgia
30.3.2 Acupuncture For Osteoarthritis
30.3.3 Acupuncture For Chronic Lower Back Pain (clbp)

Within NCD 30.3.3 Acupuncture for Chronic Low Back Pain (clbp) under the Revision History section there is an update as of 10/2024:
1737740033133.png
If you open the link to TN 12903 it opens the change request CR13818 which lists changes to 30.3.3 as follows:
1737740181816.png
The link to the spreadsheet is difficult to find but it is here:
1737740240363.png
The link opens a zip file and there is an excel file for 30.3.3 with all of the coding instructions for NCD 30.3.3 back to the original effective date which includes the CPT codes and DXs as they have been updated over the years since the benefit was created in 2020.

The forum will not let me upload the excel file so you will have to open it yourself to get the list of ICD-10 covered DXs that are covered per NCD 30.3.3. I've inserted the link below for your convenience.

https://www.cms.gov/Medicare/Coverage/DeterminationProcess/downloads/CR13818.zip
 
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