Public Comment on Medicare Payment Policies under the Physician Fee Schedule

Public Comment on Medicare Payment Policies under the Physician Fee Schedule

CSOMA has submitted a Public Comment regarding proposed changes in the 2021 CMS Fee schedule for CPT codes 97810-97814.

In summary, the proposed changes devalue acupuncture treatments to the point where it may not be financially feasible for Licensed Acupuncturists to serve Medicare beneficiaries and other insurance patients.

Page 286 of the Federal Register lists the proposed rule changes, stating:

“…That the RVUs for the acupuncture codes were based on a pair of crosswalks to two recently reviewed codes in the Dry Needling family…Due to the similar clinical nature of these services and their nearly identical work times, we believe that it is more accurate to propose cross walking CPT codes 97810 through 97814 to the work RVUs of the Dry Needling codes, which were finalized last year, as opposed to proposing work RVUs from 2004, which were never reviewed by CMS.”

The CMS is accepting public comments until October 5, 2020, by 5:00 PM. We encourage ALL practitioners and supporters of acupuncture to submit a public comment. Acupuncturists who do not accept insurance should also be encouraged to comment because this change will have an impact on our profession.

TO SUBMIT PUBLIC COMMENT

Please visit the ASA’s Public Comment on CY 2021 Payment Policies under the Physician Fee Schedule and follow the instructions for submitting public comment on this important issue.

CSOMA’s Public Comment on CY 2021 Payment Policies under PFS

Public Comment on Medicare Payment Policies under the Physician Fee Schedule

Acupuncture for Chronic Low Back Pain Approved for Medicare Beneficiaries – With Caveats

In a press release dated January 21, 2020, the Centers for Medicare & Medicaid Services (CMS) announced its decision to cover acupuncture for Medicare patients with chronic low back pain.

While this is welcome news, CSOMA would like to clarify some areas of potential confusion.

California licensed acupuncturists (LAcs), including those with doctoral titles, may not furnish acupuncture under the Medicare program, unless under the appropriate level of supervision (physician, physician assistant, or nurse practitioner/clinical nurse specialist).

Why? Per the Decision Summary, acupuncturists are not recognized by CMS as Medicare providers, and are not eligible to bill for acupuncture services.

This fact could be overlooked, given that the same document outlines the following:

“Physician assistants, nurse practitioners/clinical nurse specialists (as identified in 1861(aa)(5)), and auxiliary personnel may furnish acupuncture if they meet all applicable state requirements and have:

  • 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
  • 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.”

Despite fitting this criteria to furnish acupuncture under the Medicare program, licensed acupuncturists are considered auxiliary personnel, and as such –

“Auxiliary personnel furnishing acupuncture 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.”

Mike Morgan, CSOMA President remarked, “This decision by CMS brings us one step closer to getting acupuncture approved for licensed acupuncturists in California and nationally, so that we can deliver this medicine to all populations in need, regardless of healthcare coverage.”

In a joint letter from the ASA and NCCAOM, it was noted, “This is a monumental step towards improving access to acupuncture and licensed acupuncturists for all Americans, and we should take a moment to enjoy this evolution, which was many years in the making.”

For complete details, see the Decision Memo for Acupuncture for Chronic Low Back Pain.

CSOMA will provide updates on the topic as they become available.

Sunset Review Hearing 2018

Sunset Review Hearing 2018

On Monday, February 26, 2018, the California Acupuncture Board faced its Joint Sunset Review Hearing by the Senate Committee on Business, Professions & Economic Development and the Assembly Committee on Business and Professions. The public event was held at the State Capitol in Sacramento.

(more…)

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Tag: Medicare