Key facts for NCD 30.3.1
- Benefit category
- Incident to a physician's professional Service, Inpatient Hospital Services, Physicians' Services
- Effective date
- 01/21/2020
- Implemented 06/24/2020
- Transmittal
- Transmittal 10128
- Versions published
- 2
- Manual chapter
- 30
- NCD Manual (Pub. 100-03)
TL;DR
NCD 30.3.1 sets Medicare's national policy for acupuncture for fibromyalgia under the benefit category "Incident to a physician's professional Service, Inpatient Hospital Services, Physicians' Services", effective 01/21/2020 and implemented 06/24/2020. Effective for claims with dates of service on and after April 16, 2004, after careful reconsideration of its initial non-coverage determination for acupuncture, the Centers for Medicare & Medicaid Services (CMS) concludes that there is no convincing evidence… It has been revised 1 time since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
A. General
Acupuncture is the selection and manipulation of specific acupuncture points by a variety of needling and non-needling techniques.
Indications and limitations of coverage
B. Nationally Covered Indications
N/A for acupuncture for fibromyalgia.
C. Nationally Non-Covered Indications
Effective for claims with dates of service on and after April 16, 2004, after careful reconsideration of its initial non-coverage determination for acupuncture, the Centers for Medicare & Medicaid Services (CMS) concludes that there is no convincing evidence for the use of acupuncture for pain relief in patients with fibromyalgia. Study design flaws presently prohibit assessing acupuncture’s utility for improving health outcomes. Accordingly, CMS determines that acupuncture is not considered reasonable and necessary for the treatment of fibromyalgia within the meaning of §1862(a)(1) of the Social Security Act, and the national non-coverage determination for acupuncture for fibromyalgia continues.
D. Other
N/A
(This NCD last reviewed April 2004.)
Text reproduced from the CMS Medicare Coverage Database record for NCD 30.3.1 version 2. View the original on cms.gov.
Revision history
05/2020 - The purpose of this change request is to inform MACs that CMS will cover acupuncture for chronic low back pain (cLBP) effective for claims with dates of service on and after January 21, 2020. ( TN 10128 ) (CR11755)
04/2004 - Noncoverage for acupuncture continued. Effective and implementation dates 04/16/2004. ( TN 11 ) (CR 3250)
How this NCD shows up on remittances
A service denied under a National Coverage Determination returns CARC 50 (not deemed medically necessary) with remark N386 (decision based on an NCD); a denial citing a local policy instead carries N115. Because NCDs bind nationally, the appeal path is documentation that the patient meets the indications above, not a contractor-policy argument.
How QuickIntell applies NCD 30.3.1
QuickAuth checks the ordered service and diagnosis against NCD and LCD criteria before the encounter, QuickCode validates the diagnosis pairing on the claim, and QuickRCM routes CARC 50 denials with the policy text and the covered-code list attached so the appeal starts with evidence.
Frequently asked questions — NCD 30.3.1
What does NCD 30.3.1 cover?
Effective for claims with dates of service on and after April 16, 2004, after careful reconsideration of its initial non-coverage determination for acupuncture, the Centers for Medicare & Medicaid Services (CMS) concludes that there is no convincing evidence for the use of acupuncture for pain relief in patients with fibromyalgia. Study design flaws presently prohibit assessing acupuncture’s utility for improving… The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 30.3.1 take effect?
The current version (2) is effective 01/21/2020, implemented 06/24/2020, published in transmittal 10128. CMS lists 2 versions of this NCD.
Does a Local Coverage Determination override NCD 30.3.1?
No. A National Coverage Determination binds all Medicare Administrative Contractors; an LCD can only address services or circumstances the NCD leaves open. Claims denied under this NCD typically return CARC 50 with remark N386 (NCD) rather than N115 (LCD).
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database NCDs via the CMS Coverage APIVersion API snapshot 2026-09-27 · effective 2026-09-20 · file national-coverage-ncd.jsonSHA-256 a90fadfd264b9ef4…
Disclaimer
This page reproduces the CMS National Coverage Determination text and, for laboratory NCDs, the CMS ICD-10 edit lists, as an operational reference. Coverage decisions depend on the full policy, the claim and the contractor; nothing here is legal, clinical or billing advice. CPT codes are shown as numbers only; CPT descriptors are copyright AMA.