Acupuncture for Nausea after Chemotherapy and Post-operative Pain

CMS NCA document | source_status=Closed | review_type=New | public_comment_open=False | document_id=CAG-00062N

Issue: Acupuncture is a part of traditional Chinese medicine, a system of healing empirically derived over millennia. It has been available in the US since the 19th Century. The Food and Drug Administration has approved acupuncture needles as medical devices. Acupuncture involves shallow piercing of the skin with small needles at specific points. Traditional Chinese practitioners theorize that the points connect with energy conducting meridians, affecting spiritual, emotional, mental, and physical balance of the opposing forces of yin and yang. Western scientists suggest that stimulation with the needles may enhance or inhibit nerve conduction. Variations include electrical charges applied to the needles or warming them by burning dried herbs (moxibustion). According to section 35-8 of the Medicare Coverage Issues Manual, Medicare does not cover acupuncture. Therefore, acupuncture is not billable as a separate, distinct service. Acupuncture services may be included in some Medicare capitated payment systems. Over the last five months, HCFA's Coverage and Analysis Group has extensively reviewed literature and other sources of information on acupuncture, including the articles underlying the NIH Consensus Development Statement on Acupuncture published in 1998. We are focusing on those areas identified by the NIH Statement as most promising. Therefore, we are interested in receiving additional information on the efficacy of simple acupuncture (informed placement of needles with or without twirling, but not with electrical stimulation or moxibustion) for the following: Adult post-operative and chemotherapy pain and nausea Post -operative dental pain for dental conditions covered by Medicare, as defined in section 2136 of the Medicare Carriers Manual. We will review scientific evidence submitted about other uses for acupuncture, but we are primarily interested in the above indications. We hope for peer-reviewed literature reports of adequately powered and controlled trials, but we will study the best evidence available. Please be reminded of our need to find validity in the application of study group results to Medicare populations, best shown by clinical trials that include our beneficiaries.