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Licensed Acupuncturists Achieve Initial Goal in CMS Public Commentary Period!
On December 28, 2020, the Centers for Medicare & Medicaid Services (CMS) published their final rule (bottom of page 165 and 166 of pdf) issued December 1, 2020. It includes updates on policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, that will take place on or after January 1, 2021.
History:
Originally, CMS considered devaluing the acupuncture codes through a process called “cross-walking.” The department published intent to cross-walk 97810 through 97814 with the new trigger point acupuncture/dry needling codes 20560 and 20561 because the codes were considered to be “in the same family.”
Outrage Leads to Action:
More than 5000 comments were filed specifically regarding this section of the proposed rule, resulting in a CMS decision to abandon the process of cross-walking acupuncture codes with dry needling codes. Comments issued by ASNY and the ASA are detailed in the published exchange.
Important Outcomes:
It is incredibly important to note this victory in the process. Given that the code has not been re-evaluated since 2005, the success of keeping the codes from being cross-walked is an extraordinary victory showing the power of the industry when they come together with a unified voice. Moreover, the invitation to reevaluate the codes is an opportunity to affect federal change as well.
Also notable in this rule is the fact that the conversion factor has been reduced by $3.68 and is now down to $32.41. This plays a role in reimbursement costs per code. Currently, CMS only covers acupuncture for Chronic lower back pain and LicAcs must have appropriate supervision and cannot bill Medicare directly.)
HUGE THANKS TO Dr. Kallie Guimond, D.Ac., MPH, CEO of the health policy Advocacy institute for the compilation and authorship of this information!
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