Edward Vernon Edward Vernon

Medicare Coverage for Acupuncture: What You Need to Know

On January 21, 2020, the Centers for Medicare & Medicaid (CMS) issued a final decision stating that Medicare will now cover acupuncture for patients with chronic low back pain (cLBP). According to CMS: “The decision regarding coverage takes into account an assessment of benefits and harms and the opioid public health crisis. While a small…

On January 21, 2020, the Centers for Medicare & Medicaid (CMS) issued a final decision stating that Medicare will now cover acupuncture for patients with chronic low back pain (cLBP).

According to CMS: “The decision regarding coverage takes into account an assessment of benefits and harms and the opioid public health crisis. While a small number of adults 65 years of age or older have been enrolled in published acupuncture studies, patients with chronic low back pain in these studies showed improvements in function and pain. The evidence reviewed for this decision supports clinical strategies that include nonpharmacologic therapies for chronic low back pain. CMS notes too that while there is variation in covered indications and frequency of services, a number of large private payers provide some coverage of acupuncture for certain indications.”

Prior to finalizing its decision, CMS opened a National Coverage Analysis (NCA) for initial 30-day public comment on January 15, 2019, and another 30-day public comment period for the proposed decision memorandum posted on July 15, 2019. There were 755 and 644 comments received, respectively, for each period.

So far, here’s what is known about this expanded Medicare coverage.

What types of Low Back Pain are covered?

Medicare will cover acupuncture for chronic low back pain that meets the following criteria:

  • Lasting 12 weeks or longer;

  • Nonspecific, in that it has no identifiable systemic cause (i.e., not associated with metastatic, inflammatory, infectious, etc. disease);

  • Not associated with surgery; and

  • Not associated with pregnancy.

How many acupuncture sessions will be covered, and for how long?

Up to 12 visits in 90 days will be covered. If the patient shows improvement, an additional eight sessions may be covered.

However, no more than 20 acupuncture treatments may be administered per year. In addition, “[t]reatment must be discontinued if the patient is not improving or is regressing.”

Will Medicare cover acupuncture for conditions other than chronic low back pain?

At this time, the decision states that “[a]ll types of acupuncture including dry needling for any condition other than cLBP are non-covered by Medicare.”

Will Medicare cover dry needling?

To reiterate, “[a]ll types of acupuncture including dry needling for any condition other than cLBP are non-covered by Medicare.”

Does Medicare have any specific requirements for acupuncturists administering the chronic low back pain treatment to be covered?

Under the new Medicare coverage, physicians (as defined in 1861(r)(1)) can administer acupuncture “in accordance with applicable state requirements.”

If a non-physician (i.e. physician assistants, nurse practitioners/clinical nurse specialists (as identified in 1861(aa)(5)), and “auxiliary personnel”) will administer acupuncture, he or she must:

  • Meet all applicable state requirements;

  • Hold 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

  • Have 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 must be “under the appropriate level of supervision of a physician, physician assistant, or nurse practitioner/clinical nurse specialist required by our regulations at 42 CFR §§ 410.26 and 410.27.”

In addition, the decision states:

“Currently, acupuncturists are not recognized by CMS as Medicare providers, and are not eligible to bill for acupuncture services. It is possible, however, for acupuncturists to provide acupuncture as auxiliary personnel ‘incident to’ a physician’s service in certain settings. The incident to regulations requires supervision by a physician or other practitioner. For further details regarding ‘incident to’ services, we recommend that interested parties consult 42 CFR §§410.26 and 410.27. We are not able to amend these regulations through the national coverage determination process, however, we will change the specific reference to ‘direct supervision’ and will substitute the appropriate level of supervision required by our regulations at 42 CFR §§ 410.26 and 410.27.”

To date, CMS has yet to clarify what it means by “appropriate level of supervision” by the above mentioned personnel.

Can Licensed Acupuncturists (non-M.D.) bill Medicare for chronic low back pain treatments?

At this time, Licensed Acupuncturists cannot bill Medicare for treatment of chronic low back pain because Medicare does not allow Licensed Acupuncturist to be Medicare providers.

Where can I find more information about Medicare coverage for acupuncture for chronic low back pain?

The American Society of Acupuncturists (ASA) is in the process of addressing/clarifying the potential issues that may arise from the current CMS decision.

The full decision memo may also be accessed here.


Read More
Edward Vernon Edward Vernon

VA Shifting to Integrative Medicine to Provide Relief for Veterans

As early as the 1990s, national surveys show that at least 1 in 3 adult Americans use complementary and alternative medicine (CAM) to treat their bothersome health conditions. Indeed, there is ample evidence to suggest that Complementary and Integrative Health (CIH) practices such as acupuncture, yoga, meditation and tai chi have a…

As early as the 1990s, national surveys show that at least 1 in 3 adult Americans use complementary and alternative medicine (CAM) to treat their bothersome health conditions.  Indeed, there is ample evidence to suggest that Complementary and Integrative Health (CIH) practices such as acupuncture, yoga, meditation and tai chi have a positive effect on the well-being of veterans in particular.

Recently, the Veterans Health Administration (VHA) has been shifting towards a more holistic approach to veteran healthcare. In May 2017, for example, the agency issued VHA Directive 1137, which provides policy guidance on how CIH approaches will be incorporated into the standard veterans’ medical benefits package. Currently, the program is undergoing implementation and rebranding, though the CIH practices to be used remain the same.

Guiding Principles of VHA Directive 1137

It’s worth noting that the goal of the CIH Directive is to expand veterans’ existing healthcare options, not replace conventional treatments altogether. To quote Paragraph 4 of the Directive:

It is VHA policy that VA practitioners proactively offer and include, as appropriate (based on the individual clinical facts of each patient), any of the CIH approaches identified in the electronic lists described in paragraph 6, and to effectively integrate their delivery with Veterans’ receipt of conventional care. It is VHA policy that CIH is not to be used as an alternative to conventional medicine; it must only be used to complement conventional medicine. VA Practitioners are not to offer a CIH approach that is not on one of the two lists described… below.

List I CIH Approaches

List I approaches are defined as those with “evidence of promising or potential benefit,” and are vetted by the Integrative Health Coordinating Center (IHCC) Advisory Group. These approaches include:

  • Acupuncture

  • Meditation

  • Tai Chi

  • Yoga

  • Massage (for treatment)

  • Guided imagery

  • Biofeedback

  • Clinical hypnosis

List I approaches are to be made available to veterans across the VHA system, either through a VA facility or the local community. They must be recommended by the veterans’ healthcare team, and must be on List I at the time the specific approach is to be used for treatment.

List II CIH Approaches

List II approaches, on the other hand, are optional for inclusion in VA facilities. They’re generally considered safe by members of the medical community, and there is “reasonable certainty that [these approaches are] not harmful under the conditions of intended use.”

List II approaches include:

  • Healing touch

  • Acupressure

  • Alexander technique

  • Reflexology

  • Reiki

  • Therapeutic touch

  • Emotional freedom technique

  • Animal-assisted therapy

Like List I approaches, List II approaches must be recommended by the veterans’ healthcare providers, and must be specified as such on VHA’s Intranet Sharepoint site at the time of their use. (Note: The comprehensive list of VHA’s List I and II CIH approaches is not available to the public.)

If a veteran will use any of the above through a community, he or she must first consult the local Office of Community Care, or any related business office, to determine eligibility for CIH contract care within that community.

CIH Approaches Outside List I and II

If a veteran will use a CIH approach not included on List I or II, his or her VA healthcare provider must submit a request to the Integrative Health Coordinating Center Advisory Workgroup (IHCCAW).

The IHCCAW will escalate the request to the IHCC, which in turn will escalate to the Whole Health Experience Committee (WHEC), and then to the Under Secretary for Health. The Under Secretary for Health has the final authority to approve the request, though the IHCC may also deny the request unilaterally.

In any case, the IHCCAW will be the one to inform the requestor regarding the final decision. If the Under Secretary approves the request, the list of sanctioned CIH approaches in the VHA system will be updated accordingly.

As of this writing, the CIH program is in the implementation phase, meaning that the specifics of the program may still be changed or updated. Regardless, there’s no doubt that holistic healthcare for veterans is now more accessible, more systematized, and more able to serve veterans’ medical needs.  

Read More
Edward Vernon Edward Vernon

What is the Best Heart Rate for Fat Loss?

Hint: It’s not 220 minus your age. As you know, tracking your heart rate during exercise is important. Aside from showing how intense your workout is, your heart’s beats per minute (BPM) is also a good indicator of overall cardiovascular health. But what makes a “healthy” heart rate? What heart rate should you aim for during exercise to…

Hint: It’s not 220 minus your age.

As you know, tracking your heart rate during exercise is important. Aside from showing how intense your workout is, your heart’s beats per minute (BPM) is also a good indicator of overall cardiovascular health.

But what makes a “healthy” heart rate? What heart rate should you aim for during exercise to meet your fitness goals? Answers to those questions (and more) are below.

What Your Heart Does

The main function of your heart is to pump blood, which carries oxygen, throughout your body. In general, a lower heart rate is better — especially if you’re at rest — because it means your heart isn’t working too hard and wearing itself out too quickly.

Even during exercise, when your heart rate goes up due to your body’s increased need for oxygen, it’s important that you don’t overexert yourself to the point that you’ll increase your chances of injury. You need to find a balance between raising your heart rate enough to enjoy the full benefits of exercise, and keeping it low enough to avoid stressing your body.

That’s where calculating your target heart rate comes in.

Use the 180 Formula Instead

Traditionally, the target heart rate is calculated as the difference between 220 and your age (also known as your maximum heart rate), multiplied by a percentage based on the intensity of the activity you’re engaged in.

For example, if you’re a 30-year-old engaged in moderate intensity exercise, your target heart rate is between 95 to 131 beats per minute — since your maximum heart rate is 190 (220 – 30), and your BPM for moderate intensity exercises is between 50 to 69 percent of your maximum heart rate.

Although the 220 formula is appealing for its simplicity, clinician Dr. Phil Maffetone found that athletes who use the formula often end up overtrained, or experiencing problems during workouts. To work around this, Dr. Maffetone created the 180 formula as follows.

  1. Get the difference between your age and 180.

  2. Add/Subtract from the result, depending on your fitness and health profile.

  3. If you’re currently recovering from a major illness or injury, subtract 10.

  4. If you’re injured, suffer from illness on a regular basis, or train for inconsistent periods of time, subtract 5.

  5. If you train consistently for at least four times per week, and haven’t suffered any of the above, don’t add/subtract anything.

  6. If you train consistently for at least two years, haven’t suffered any of the problems mentioned in the first two points, and have progressed in competition without injury, add 5.

The result will be your ideal maximum heart rate during exercise. It may seem a little slow at first, but over time your body will quicken its pace at a lower heart rate, lightening the stress on your heart without sacrificing the intensity required to stay fit.

Keep in mind, however, that the formula isn’t applicable across the board. If you are over 65, under 16, or someone who is taking medication/has a heart condition that precludes you from intense exercises, it’s better to consult a professional who’s familiar with the 180 formula.

What do you think of the 180 formula? Have you tried it out for yourself? Give us a nudge in the comments, or have your say over at our Facebook page.

Read More