LCD/NCD Portal

NCD30.3

 

ACUPUNCTURE

 

Effective Date of this Version

• This is a longstanding national coverage determination. The effective date of this version has not been posted.

 

Benefit Category

• Incident to a physician's professional Service.

• Inpatient Hospital Services.

• Outpatient Hospital Services Incident to a Physician's Service.

• Physicians' Services.

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

 

Indications and Limitations of Coverage

• Although acupuncture has been used for thousands of years in China and for decades in parts of Europe, it is a 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 have been designed to assess and identify specific opportunities and needs for research attending the use of acupuncture for surgical anesthesia and relief of chronic pain.

• Until the pending scientific assessment of the technique has been completed and its efficacy has been established, Medicare reimbursement for acupuncture, as an anesthetic or as an analgesic or for other therapeutic purposes, may not be made.

• Accordingly, acupuncture is not considered reasonable and necessary within the meaning of §1862(a)(1) of the Act.

 

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

• Original consideration for Acupuncture for Nausea after Chemotherapy and Post-operative Pain (CAG-00062N) opens in new window

• Original consideration for Acupuncture for Osteoarthritis (CAG-00175N) opens in new window

 

Medicare NCD Link