National Coverage Analysis (NCA) Tracking Sheet

Acupuncture for Fibromyalgia

CAG-00174N

Issue

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.

Fibromyalgia is a widespread musculoskeletal pain and fatigue disorder for which the cause is still unknown. Fibromyalgia means pain in the muscles, ligaments and tendons the fibrous tissues in the body.

A Requestor has asked that CMS change the current national coverage determination from one of non-coverage of acupuncture to allow national coverage of this therapy. CMS will review the scientific evidence and determine if this procedure would be a reasonable and necessary service for Medicare beneficiaries.

Benefit Category

Incident to a physician's professional Service
Inpatient Hospital Services
Physicians' Services

Requestor Information

Requestor Name Requestor Letter
Mr. Jay Silverman N/A
N/A

Important Dates

Formal Request Accepted and Review Initiated
12/02/2002
Expected NCA Completion Date
08/18/2003
Public Comment Period
01/02/2003 - 02/02/2003
Proposed Decision Memo Due Date
Proposed Decision Memo Released
Proposed Decision Memo Public Comment Period
Decision Memo Released
10/10/2003

Contacts

Lead Analysts
Samantha N. Richardson
Lead Medical Officers
Lawrence Schott, MD, MS
Carlos Cano, MD

Medicare Benefit Category Determination Date

Actions Taken

December 2,2002

CMS staff worked with requestor to complete formal request, including gathering appropriate evidence, and formally accepted request today for review.

February 26, 2003

CMS has requested a Technology Assessment (TA) from the Agency for Healthcare Research and Quality (AHRQ) on for a review of the literature available on acupuncture. The CMS Decision Memorandum will be posted within 60 days of receipt of the TA.

[Date entered in Expected Completion Date field is an approximation.]

June 18, 2003

CMS has received Technology Assessment from AHRQ. It can be found at www.cms.hhs.gov/coverage/download/id83.pdf. Decision will be made in 60 days.

October 10, 2003

Decision Memorandum has been posted to our website.