Humana Complementary and Alternative Medicine - Medicare Advantage Form

Please refer to CMS website for the most current applicable CMS Online Manual System (IOMs)/National Coverage Determination (NCD)/ Local Coverage Determination (LCD)/Local Coverage Article (LCA)/ Transmittals.

Complementary and Alternative Medicine

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• NCD Acupuncture for Chronic Lower Back Pain (cLBP) - 30.3.3
• NCD Acupuncture for Fibromyalgia - 30.3.1
• NCD Acupuncture for Osteoarthritis - 30.3.2
• NCD Cellular Therapy - 30.8
• NCD Colonic Irrigation - 100.7
• NCD Intravenous Histamine Therapy - 30.6
• NCD Laetrile and Related Substances - 30.7
• NCD Thermogenic Therapy - 30.2
• NCD Transcendental Meditation - 30.5
• LCA Billing and Coding: Auricular Peripheral Nerve Stimulation (Electro-Acupuncture Device) - A55240 Jurisdiction Medicare Contractors (MACs): JH - Novitas Solutions, Inc. (Part A/B MAC), JL - Novitas Solutions, Inc. (Part A/B MAC) Applicable States/Territories: AR, CO, NM, OK, TX, LA, MS DE, D.C., MD, NJ, PA

Description Complementary and alternative medicine (CAM) is a group of diverse medical and health care systems, practices and products that are not generally considered to be part of conventional medicine (eg, Western medicine). In general, CAM can be separated into two main subgroups: nutritional approaches and psychological and/or physical approaches.

• Nutritional approaches include a variety of products, such as herbs (eg, botanicals), probiotics, vitamins and minerals. They are widely marketed, readily available and often sold as dietary supplements.
• Psychological and/or physical approaches use a variety of techniques such as hypnosis, massage, meditation, music and relaxation therapy. These approaches are often administered or taught by a trained practitioner or teacher.
• Other complementary health approaches may not fit into either of the above groups. Examples may include the practices of traditional healers, Ayurvedic medicine, traditional Chinese medicine, homeopathy and naturopathy.

Coverage Determination

Complementary and Alternative Medicine

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Humana follows the CMS requirements that only allows coverage and payment for services that are reasonable and necessary for the diagnosis and treatment of illness or injury or to improve the functioning of a malformed body member except as specifically allowed by Medicare.

Please refer to the above CMS guidance for Complementary and Alternative Medicine.

In interpreting or supplementing the criteria above and in order to determine medical necessity consistently, Humana may consider the following criteria:

• Complementary and Alternative Medicine The use of the criteria in this Medicare Advantage Medical Coverage Policy provides clinical benefits highly likely to outweigh any clinical harms. Services that do not meet the criteria above are not medically necessary and thus do not provide a clinical benefit. Medically unnecessary services carry risks of adverse outcomes and may interfere with the pursuit of other treatments which have demonstrated efficacy.

Coverage Limitations

US Government Publishing Office. Electronic code of federal regulations: part 411 – 42 CFR § 411.15 - Particular services excluded from coverage