CMS TO COVER ACUPUNCTURE – IMPACT ON PERSONAL INJURY CLAIMS.
***NEWSLETTER***
"This blog post is intended solely for educational and informational purposes and does not constitute legal advice. The content herein should not be relied upon as a substitute for professional legal consultation. Reading this post does not create an attorney-client relationship with The Lien Project, PC or any of its attorneys. For personalized legal guidance, please consult The Lien Project, PC."
As alternative medical treatments—such as acupuncture—become more widely utilized alongside conventional care, personal injury victims often face hurdles when seeking reimbursement for that care. For years, we’ve heard insurance carriers argue that acupuncture is not “medically necessary,” frequently citing CMS’s historical refusal to reimburse for such services as support for that position.
That argument no longer holds.
On January 20, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a final coverage memorandum confirming that acupuncture for chronic low back pain (CLBP) is now covered. (The coverage memo can be found here.)
This decision came after a series of CMS-approved studies that outlined the parameters under which acupuncture would be reimbursed. While coverage is currently limited to CLBP, we anticipate that the range of diagnoses approved for acupuncture coverage by CMS will continue to expand over time.
In personal injury litigation, this change provides a stronger foundation for claiming and recovering the costs of acupuncture as past medical special damages, particularly for low back injuries. Where insurers previously leaned on CMS’s non-coverage to challenge the necessity of such treatment, that rationale has been significantly weakened.
Additionally, because the CMS decision focuses on “chronic” low back pain, future medical expenses for acupuncture care is likely to be in play and such care will impact Medicare set-aside analysis and planning.
This development marks a critical step in legitimizing acupuncture and other integrative therapies as compensable and medically necessary—a win for both injured plaintiffs and the providers who care for them.
Explore More Resources with Lien Project Network
For a deeper dive into lien resolution strategies, settlement planning, and reimbursement challenges, explore our educational modules. Lien Project Network serves as a trusted resource for plaintiff attorneys, providing insights on financial planning, public benefits, and structured settlements in the context of lien management.
Need Assistance? Work With The Lien Project, PC
If you need expert legal assistance in navigating lien resolution, reimbursement claims, or settlement planning, our team at The Lien Project, PC is ready to help. As an LPN member, you earn credits that can be applied toward lien reduction and resolution services provided by The Lien Project, PC, allowing you to offset up to $900 per year. Your investment in continuing education through Lien Project Network not only enhances your lien resolution skills but also reduces the cost of engaging legal experts when needed.
Schedule a Consult today to see how we can help maximize your client’s recovery.