National Coverage Determination (NCD)

Acupuncture for Fibromyalgia

30.3.1

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Tracking Information

Publication Number
100-3
Manual Section Number
30.3.1
Manual Section Title
Acupuncture for Fibromyalgia
Version Number
2
Effective Date of this Version
01/21/2020
Implementation Date
06/24/2020

Description Information

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


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

Item/Service Description

A. General

Acupuncture is the selection and manipulation of specific acupuncture points by a variety of needling and non-needling techniques.

Indications and Limitations of Coverage

B. Nationally Covered Indications

N/A for acupuncture for fibromyalgia.

C. Nationally Non-Covered Indications

Effective for claims with dates of service on and after April 16, 2004, after careful reconsideration of its initial non-coverage determination for acupuncture, the Centers for Medicare & Medicaid Services (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 non-coverage determination for acupuncture for fibromyalgia continues.

D. Other

N/A

(This NCD last reviewed April 2004.)

Claims Processing Instructions

Transmittal Information

Transmittal Number
10128
Revision History

04/2004 - Noncoverage for acupuncture continued. Effective and implementation dates 04/16/2004. (TN 11) (CR 3250)

05/2020 - The purpose of this change request is to inform MACs that CMS will cover acupuncture for chronic low back pain (cLBP) effective for claims with dates of service on and after January 21, 2020. (TN 10128) (CR11755)

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.

Additional Information

Other Versions
Title Version Effective Between
Acupuncture for Fibromyalgia 2 01/21/2020 - N/A You are here
Acupuncture for Fibromyalgia 1 04/16/2004 - 01/21/2020 View