LCD/NCD Portal

NCD30.3.1

 

ACUPUNCTURE FOR FIBROMYALGIA

 

Effective Date of this Version

4/16/2004

 

Benefit Category

• Incident to a physician's professional Service.

• Inpatient Hospital Services.

• Physicians' Services.

• Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

 

Item/Service Description

 

General

• Although acupuncture has been used for thousands of years in China and for decades in parts of Europe, it is still a relatively new agent of unknown use and efficacy in the United States.

• Even in those areas of the world where it has been widely used, its mechanism is not known.

• Three units of the National Institutes of Health, the National Institute of General Medical Sciences, National Institute of Neurological Diseases and Stroke, and Fogarty International Center were designated to assess and identify specific opportunities and needs for research attending the use of acupuncture for surgical anesthesia and relief of chronic pain.

• Following thorough review, and pending completion of the scientific assessment and efficacy of the technique, CMS initially issued a national noncoverage determination for acupuncture in May 1980.

 

Indications and Limitations of Coverage

 

Nationally Covered Indications

• Not applicable.

 

Nationally Noncovered Indications

• After careful reconsideration of its initial noncoverage determination for acupuncture, CMS concludes that there is no convincing evidence for the use of acupuncture for pain relief in patients with fibromyalgia.

• Study design flaws presently prohibit assessing acupuncture’s utility for improving health outcomes.

• Accordingly, CMS determines that acupuncture is not considered reasonable and necessary for the treatment of fibromyalgia within the meaning of §1862(a) (1) of the Social Security Act, and the national noncoverage determination for acupuncture continues.

• (This NCD last reviewed April 2004.)

 

Coverage Transmittal Link

http://www.cms.gov/transmittals/downloads/R11NCD.pdf

 

National Coverage Analyses (NCAs)

• This NCD has been or is currently being reviewed under the National Coverage Determination process.

• The following are existing associations with NCAs, from the National Coverage Analyses database.

• Original consideration for Acupuncture for Fibromyalgia (CAG-00174N) opens in new window

 

Medicare NCD Link