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CMS Seeks to Expand Services through Recent Coverage Decisions (Acupuncture for Low Back Pain and NGS for Advanced Breast and Ovarian Cancer)

January 28, 2020

McDermott+Consulting

The Centers for Medicare and Medicaid Services has announced two coverage decisions that will provide access to previously uncovered services for Medicare fee-for-service (FFS) beneficiaries.

On January 21, 2002, CMS released a decision memo to cover acupuncture for Medicare patients with chronic low back pain. CMS will cover up to 12 sessions in 90 days with an additional eight sessions for those patients with chronic low back pain who demonstrate improvement. Before this final National Coverage Determination (NCD) reconsideration, acupuncture was nationally non-covered by Medicare. With this decision, CMS is seeking to increase access to alternatives to prescription opioids. In a press release on the decision, CMS notes that while there is variation in covered indications and frequency of services, a number of large private payers provide some coverage of acupuncture for certain indications.

On January 27, 2020, CMS announced they are expanding coverage of Next Generation Sequencing (NGS) as a diagnostic tool for patients with breast and ovarian cancer. CMS will cover FDA approved or cleared laboratory diagnostic tests using NGS for patients with germline (inherited) ovarian or breast cancer. Recognizing that innovation is happening quickly and evidence is moving fast, CMS will give contractors discretion over whether to cover NGS for certain other indications.

 

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For more information visit the McDermottPlus Payment Innovation Resource Center or contact Sheila Madhani at 202-204-1459 or smadhani@mcdermottplus.com.

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