Effective January 1, 2020, there were 2 new CPT codes to describe dry needling. They are as follows:
- 20560 – Needle insertion(s) without injection(s), 1 or 2 muscle(s)
- 20561 – Needle insertion(s) without injection(s), 3 or more muscle(s)
Unfortunately, the Centers for Medicare and Medicaid Services (CMS) gave these 2 CPT codes a non-covered status for payment under the Medicare Physician Fee Schedule (MPFS). This meant that if a physical therapist performed dry needling on a Medicare beneficiary who had traditional Medicare as their insurance, CMS would not pay for this service. Since dry needling is non-covered by CMS, this means the Medicare beneficiary would be financially responsible for the cost and the provider of the dry needling service(s) would not be required to issue an advance beneficiary notice of noncoverage (ABN) since an ABN is only issued when the services are normally covered by the Medicare program but under the circumstance, the provider does not think the Medicare program will pay.
On January 21, 2020, CMS issued a decision memo for Acupuncture for Chronic Low Back Pain. In the Decision Summary, CMS states the following:
“The Centers for Medicare & Medicaid Services (CMS) will cover acupuncture for chronic low back pain under section 1862(a)(1)(A) of the Social Security Act. Up to 12 visits in 90 days are covered for Medicare beneficiaries under the following circumstances:
- For the purpose of this decision, chronic low back pain (cLBP) is defined as:
- Lasting 12 weeks or longer;
- nonspecific, in that it has no identifiable systemic cause (i.e., not associated with metastatic, inflammatory, infectious, etc. disease);
- not associated with surgery; and
- not associated with pregnancy.
- An additional eight sessions will be covered for those patients demonstrating an improvement. No more than 20 acupuncture treatments may be administered annually.
- Treatment must be discontinued if the patient is not improving or is regressing”.
This Decision Memo has now created confusion as physical therapists now want to know is dry needling now covered for chronic low back in Calendar Year 2020? The answer is
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