CMS Pub. 100-03, ch. 1, § 30.3.3

A. General

Acupuncture is the selection and manipulation of specific acupuncture points by a

variety of needling and non-needling techniques.

B. Nationally Covered Indications

Effective for services performed on or after January, 21, 2020, CMS will cover

acupuncture for Medicare patients with chronic Lower Back Pain (cLBP.) Up to 12

visits in 90 days are covered for Medicare beneficiaries under the following

circumstance:

• For the purpose of this decision, cLBP is defined as:

o Lasting 12 weeks or longer;

o nonspecific, in that it has no identifiable systemic cause (i.e., not

associated with metastatic, inflammatory, infectious, etc. disease);

o not associated with surgery; and,

o not associated with pregnancy.

• An additional 8 sessions will be covered for those patients demonstrating an

improvement.

• No more than 20 acupuncture treatments may be administered annually.

• Treatment must be discontinued if the patient is not improving or is regressing.

Physicians (as defined in 1861(r)(1) of the Social Security Act (the Act) may furnish

acupuncture in accordance with applicable state requirements.

Physician assistants (PAs), nurse practitioners (NPs)/clinical nurse specialists

(CNSs) (as identified in 1861(aa)(5) of the Act), and auxiliary personnel may

furnish acupuncture if they meet all applicable state requirements and have:

• a masters or doctoral level degree in acupuncture or Oriental Medicine from a

school accredited by the Accreditation Commission on Acupuncture and Oriental

Medicine (ACAOM); and,

• a current, full, active, and unrestricted license to practice acupuncture in a State,

Territory, or Commonwealth (i.e. Puerto Rico) of the United States, or District of

Columbia.

Auxiliary personnel furnishing acupuncture must be under the appropriate level of

supervision of a physician, PA, or NP/CNS required by our regulations at 42 CFR

§§ 410.26 and 410.27.

C. Nationally Non-Covered Indications

All types of acupuncture including dry needling for any condition other than cLBP are

non-covered by Medicare.

D. Other

N/A

(This NCD last reviewed January 2020.)