by Wyn Staheli, Director of Research
February 19th, 2020
On January 20, 2020, Medicare announced that they would begin covering acupuncture for the treatment of chronic low back pain. However, the way that it is currently worded, a chiropractor cannot ‘order’ acupuncture, BUT they may provide the services as an auxiliary provider as long as it is ordered by a physician and meets ALL the NCD requirements. Let’s look at the wording of the NCD (emphasis added):
Physicians (as defined in 1861(r)(1)) may furnish acupuncture in accordance with applicable state requirements.
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.
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.
This all goes back to the original problem of Medicare’s definition of a physician and how they define a doctor of chiropractic. The following (emphasis added) is their physician definition as found in section 1861(r):
(r) The term “physician”, when used in connection with the performance of any function or action, means
(1) a doctor of medicine or osteopathy legally authorized to practice medicine and surgery by the State in which he performs such function or action (including a physician within the meaning of section 1101(a)(7)),
(2) a doctor of dental surgery or of dental medicine who is legally authorized to practice dentistry by the State in which he performs such function and who is acting within the scope of his license when he performs such functions,
(3) a doctor of podiatric medicine for the purposes of subsections (k), (m), (p)(1), and (s) of this section and sections 1814(a), 1832(a)(2)(F)(ii), and 1835 but only with respect to functions which he is legally authorized to perform as such by the State in which he performs them,
(4) a doctor of optometry, but only for purposes of subsection (p)(1) of this section and with respect to the provision of items or services described in subsection (s) which he is legally authorized to perform as a doctor of optometry by the State in which he performs them, or
(5) a chiropractor who is licensed as such by the State (or in a State which does not license chiropractors as such, is legally authorized to perform the services of a chiropractor in the jurisdiction in which he performs such services), and who meets uniform minimum standards promulgated by the Secretary, but only for the purpose of sections 1861(s)(1) and 1861(s)(2)(A) and only with respect to treatment by means of manual manipulation of the spine (to correct a subluxation) which he is legally authorized to perform by the State or jurisdiction in which such treatment is provided. For the purposes of section 1862(a)(4) and subject to the limitations and conditions provided in the previous sentence, such term includes a doctor of one of the arts, specified in such previous sentence, legally authorized to practice such art in the country in which the inpatient hospital services (referred to in such section 1862(a)(4)) are furnished.
Chiropractors who are ACAOM certified and licensed in their state to provide acupuncture may wish to take this opportunity to work with other physicians and provide these services under the 'Auxiliary personnel' provision of this NCD. For more comprehensive information about Medicare’s ruling and all the requirements, CLICK HERE for an excellent article.
Update: Please pay very close attention to the requirements. The ACA's 100 hour certification is not sufficient. You must also meet all of your state requirements for an acupuncture license. You must also meet the 'incident to' requirements (see 42 CFR §§ 410.26 and 410.27). CLICK HERE and carefully review the section on "Chiropractors Performing Acupuncture Services."
In summary, you must meet ALL three of the following requirements:
- 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)
- A current, full, active, and unrestricted license to practice acupuncture in your state (includes territory, or commonwealth (i.e. Puerto Rico) of the United States, or District of Columbia)
- As an 'Auxiliary personnel' the chiropractor must be under the appropriate level of supervision to meet Medicare's 'incident to' requirements