National Coverage Analysis (NCA) Tracking Sheet

Acupuncture for Chronic Low Back Pain



Acupuncture is a technique in which practitioners stimulate specific points on the body, most often by inserting thin needles through the skin. It may be used to alleviate pain and to treat various physical, mental and emotional conditions.

Low back pain is a common condition affecting many individuals at some point in their lives. Some individuals will develop chronic low back pain (CLBP), which is an episode of low back pain that has persisted for three months or longer.

In response to the U.S. opioid crisis, HHS is focused on preventing opioid use disorder and providing more evidence-based non-pharmacologic treatment options for chronic pain. The Agency for Healthcare Research and Quality (AHRQ), the Centers for Medicare & Medicaid Services (CMS) and that National Institutes of Health (NIH) are collaborating in this effort. The Agency for Healthcare Research and Quality published a systematic review of noninvasive, nonpharmacological treatment for chronic pain in June 2018 ( This review included assessment of several nonpharmacological interventions, including exercise, acupuncture, spinal manipulation, and multidisciplinary rehabilitation for CLBP. The NIH recently issued a Funding Opportunity Announcement for interested parties to apply to conduct an efficient, large-scale pragmatic trial to evaluate the impact of, and strategies to best implement, acupuncture treatment of older adults (65 years and older) with chronic low back pain. The announcement can be found here:

CMS is opening this national coverage analysis (NCA) to complete a thorough review of the evidence to determine if acupuncture for CLBP is reasonable and necessary under the Medicare program. CMS is soliciting public comment on this topic. We are particularly interested in comments that include scientific evidence and discuss appropriate clinicians and training requirements to provide acupuncture that improves health outcomes. In addition, for commenters recommending Coverage with Evidence Development, we are interested in comments related to appropriate outcomes and study designs. While CMS has conducted previous national coverage analyses on acupuncture, the scope of this current review is limited to acupuncture for chronic low back pain.

Benefit Category

Incident to a physician's professional Service
Inpatient Hospital Services
Physicians' Services

Requestor Information

Requestor Name Requestor Letter
Internally generated N/A

Important Dates

Formal Request Accepted and Review Initiated
Expected NCA Completion Date
Public Comment Period
01/15/2019 - 02/14/2019
Proposed Decision Memo Due Date
Proposed Decision Memo Released
Proposed Decision Memo Public Comment Period
07/15/2019 - 08/14/2019
Decision Memo Released
Comments for this NCA
View Public Comments


Lead Analysts
David Dolan
Lead Medical Officers
Susan Miller, MD

Medicare Benefit Category Determination Date

Actions Taken

January 15, 2019

CMS initiates this national coverage analysis for Acupuncture for Chronic Low Back Pain. The initial 30-day public comment period begins with this posting date, and ends after 30 calendar days. CMS considers all public comments, and is particularly interested in clinical studies and other scientific information relevant to the topic under review.

Instructions on submitting comments can be found at: To submit a comment, please use the orange "Comment" button at the top of the page. Enter comments directly into the "Submit A Public Comment" webpage.

July 15, 2019

October 11, 2019

CMS will not be issuing a final National Coverage Determination on Acupuncture for Chronic Low Back Pain today, but a decision is forthcoming.

January 21, 2020