CMS Acupuncture Coverage for Chronic Lower Back Pain: What Billing Teams Need to Know About NCD 373

CMS has modified National Coverage Determination (NCD) 373, which governs Medicare coverage for acupuncture in the treatment of chronic lower back pain (cLBP). The Centers for Medicare & Medicaid Services first established this coverage effective January 21, 2020, making acupuncture one of the few complementary therapies with an explicit Medicare coverage pathway—and this 2026 update brings renewed attention to the specific criteria that determine whether a claim will be paid or denied.

What CMS Covers Under NCD 373: The cLBP Definition That Determines Every Claim

The coverage hinge in NCD 373 is a narrow, four-part definition of chronic lower back pain. For a patient to qualify, the condition must meet all four of the following criteria simultaneously:

• Duration: Lasting 12 weeks or longer
• Nonspecific origin: No identifiable systemic cause—meaning not associated with metastatic, inflammatory, or infectious disease
• Not surgery-related: The back pain must not be associated with surgery
• Not pregnancy-related: The condition must not be associated with pregnancy

Miss any one of these, and the service is non-covered under Medicare. This is the definition your billing team needs to document against at every encounter. ICD-10 selection matters here—diagnosis codes pointing to a specific systemic etiology will undermine medical necessity before the claim even reaches adjudication.

CMS Acupuncture Visit Limits: The 90-Day Rule and Annual Cap

NCD 373 establishes a tiered visit structure that your scheduling and billing workflows must track carefully:

• Up to 12 visits are covered within the first 90 days for qualifying cLBP patients
• An additional 8 sessions are covered for patients who demonstrate measurable improvement
• No more than 20 acupuncture treatments may be administered in any annual period
• Treatment must be discontinued if the patient is not improving or is regressing

That last point is critical: continuing to bill acupuncture for a patient who has plateaued or declined is not just a coverage issue—it creates medical necessity exposure. Documentation at every visit should explicitly address whether the patient is improving, maintaining, or declining.

The 12 + 8 structure means you'll also want clear workflows for re-authorizing the additional 8 sessions. While NCD 373 does not specify a prior authorization requirement, Medicare Administrative Contractors (MACs) may apply local coverage policies layered on top of this NCD—check your MAC's LCDs for any additional documentation requirements in your jurisdiction.

Who Can Bill Medicare Acupuncture Under NCD 373: Provider Qualification Requirements

This is one of the more consequential aspects of NCD 373, and it trips up billing teams at practices where acupuncture is furnished by non-physician staff.

Physicians (as defined under Section 1861(r)(1) of the Social Security Act) may furnish acupuncture consistent with applicable state requirements—no additional acupuncture-specific credentialing is required at the federal level for MDs and DOs.

Physician assistants (PAs), nurse practitioners (NPs), and clinical nurse specialists (CNSs) may furnish acupuncture only if they meet all of the following:

1. Compliance with all applicable state requirements
2. A master's or doctoral level degree in acupuncture or Oriental Medicine from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine (ACAOM)
3. A current, full, active, and unrestricted license to practice acupuncture in a U.S. state, territory, commonwealth, or the District of Columbia

Auxiliary personnel may also furnish acupuncture under NCD 373, provided they meet the same degree and licensure requirements as PAs/NPs/CNSs, and that they operate under the appropriate level of supervision by a physician, PA, or NP/CNS as required by 42 CFR §§ 410.26 and 410.27.

If your practice uses auxiliary acupuncturists billing incident-to a physician's service, review those supervision arrangements against the 42 CFR requirements now. Incident-to billing is explicitly recognized as a benefit category under NCD 373, but the supervision rules are non-negotiable.

What Is Not Covered: Dry Needling and All Other Acupuncture Indications

CMS is explicit: all types of acupuncture, including dry needling, for any condition other than cLBP are non-covered by Medicare. There is no coverage pathway for acupuncture to treat migraines, osteoarthritis, chemotherapy-induced nausea, or any other indication regardless of clinical evidence.

This matters operationally because dry needling is sometimes billed under physical therapy or neuromuscular codes at practices offering both acupuncture and PT services. If a Medicare patient is receiving dry needling, that service is non-covered under this NCD regardless of how it is coded. Do not attempt to route dry needling claims for Medicare patients through acupuncture codes.

Affected Codes

NCD 373 as published does not list specific CPT or HCPCS codes within the policy document. Your MAC's claims processing instructions—specifically Transmittals TN 10128, TN 10337, and TN 12185—contain the applicable claims processing guidance. Billing teams should download and review those transmittals directly from CMS to confirm the correct procedure codes accepted in their jurisdiction.

Covered services (per policy criteria):

Non-covered services:

No specific CPT or HCPCS codes are listed in the published NCD 373 policy document. Reference MAC transmittals TN 10128, TN 10337, and TN 12185 for claims processing codes.

What Your Billing Team Should Do