Contractor Name
HealthNow UMD

Contract Number
00801

Contractor Type
Carrier

LCD Database ID Number
L3616

LCD Title
Alternative Medicine

Contractor's Determination Number
M-95-3 (1A) End dated

AMA CPT Copyright Statement
CPT codes, descriptions, and other data only are copyright 2003 American Medical Association (or such other data of publication of CPT). All Rights Reserved. Applicable FARS/DFARS clauses apply. CDT-4 codes and descriptions are copyright 2003 American Dental Association. All rights reserved.

CMS National Coverage Policy

   -   Carrier Medicare Manual - Section 3045.1G - Noncovered Services

       Medicare's Coverage Issues Manual - Section 50-2 - Cytotoxic Food
       Tests

   -   CMS Manual System, Pub. 100-2, Medicare Benefit Policy, Chapter 15,
       Section 50

       This section contains information relative to payment of Drugs and
       Biologicals.

   -   CMS Manual System, Pub. 100-03, Medicare National Coverage
       Determinations Manual, Chapter 1, Section 30.3.1-30.3.2

       This section contains information relative to noncoverage of
       acupuncture.

Oversight Region
Region II

CMS Consortium
Northeast

Original Determination Effective Date
12/01/1995

Original Determination Ending Date
05/05/2008

Revision Effective Date
04/16/2004

Revision Ending Date
05/05/2008

Indications and Limitations of Coverage and/or Medical Necessity
Alternative medicine is an accumulation of nonconventional or nontraditional methods of diagnosing and treating disease and/or illness and injury. It may encompass such practices known as:

   1.  Naturopathic Medicine - A system of treatment that makes use of such
       physical agents as light, heat, water, massage, exercise and diet.  No
       surgical procedures are used and only such medications as are derived
       from herbs, vitamins, etc.

   2.  Homeopathy Medicine - A system of medicine that is based on the Law of
       Similars, which attempts to stimulate the body to heal itself.  The
       basic principle is similia similibus curantu, or "like treats like."
       It includes therapies using such products as antioxidants, oxidizing
       agents, cellular and chelation therapies and hydrogen peroxide.

   3.  Environmental Medicine - A system that takes into consideration types
       of disorders at least in part from adverse reactions to any
       combination of a multitude of environmental or internal substances
       such as biologic inhalants, venoms, food and chemicals.

   4.  Holistic Medicine - A system of preventive medicine that takes into
       account the whole individual, his/her own responsibility for his/her
       well being and the total influences - social, psychological,
       environmental - that affect health including nutrition, exercise and
       mental relaxation.  Mind/body control may include art, relaxation
       therapy, meditation, hypnosis, music therapy, guided imagery, etc.

   5.  Traditional Ethnomedicine - Includes acupuncture, transcendental
       meditation, oriental medicines, nutritional supplements, such as bee
       pollen and herbal medicines.

   6.  Clinical Ecology (Multiple Chemical Sensitivity Syndrome) - Is defined
       as the orientation in medicine in which physicians primarily work with
       patients to uncover the cause-and-effect relationship between their
       ill health and food or low level chemical exposure.

   1.  Acupuncture for the treatment of fibromyalgia and osteoarthritis is
       not covered by Medicare Part B as not reasonable and necessary within
       the meaning of Section 1862(a)(1) of the Social Security Act.

   2.  Some tests that are associated with alternative medicine which would
       not be reimbursed by Medicare Part B are (this should not be
       considered an all inclusive list):

       a)   Cytotoxic Leukocyte Tests for food allergies are excluded from
            Medicare coverage effective August 5, 1985 because available
            evidence does not show that these tests are safe and effective.

       b)   Challenge Ingestion Food Testing has not proven to be effective
            in the diagnosis of rheumatoid arthritis, depression or
            respiratory disorders.  Accordingly, its use in the diagnosis of
            these conditions is not reasonable and necessary within Medicare
            law.

       c)   Sublingual Antigen Administration (Provocative Testing,
            Sublingual) for treatment for atopic disease is not covered.
            This technique is used for the diagnosis and treatment of
            food-induced respiratory, gastrointestinal, and other systemic
            symptoms.  There has been no controlled clinical studies
            indicating a diagnostic or therapeutic effect and there are no
            known immunologic mechanisms that can account for the
            "neutralizing effects" of diluted solutions of allergenic
            extracts.  Therefore, sublingual provocative testing and
            desensitization is considered experimental.

       d)   Urine Autoinjection - Autogenous urine injection therapy for
            allergic diseases is not standard medical practice.  Treatment
            has not proven effective or safe by published studies.  There is
            no rationale or immunologic basis for this treatment.  Therefore,
            urine autoinjection is considered experimental.

       e)   Skin End Point Titration used to determine therapeutic dose for
            immunotherapy should be reserved for experimental use only.

       f)   Provocative and Neutralization Testing (Subcutaneous) is a
            technique used for the diagnosis and treatment of allergic
            disease in which a subcutaneous injection of antigen of
            sufficient quantity is administered to elicit symptoms
            corresponding to the patient's complaints.  Then this is followed
            by immediate injection of weaker or stronger dilution of the same
            antigen to relieve provoked symptoms.  This technique is
            considered experimental.

       g)   An objective evaluation of the diagnostic and therapeutic
            principles used to support the concept of clinical ecology
            indicated that it is an unproven and experimental methodology.

CPT/HCPCS Codes
N/A

Does the CPT 30% Coding Rule Apply?
No

ICD-9-CM Codes That Support Medical Necessity
N/A

ICD-9-CM Codes That DO NOT Support Medical Necessity:
N/A

Documentation Requirements
N/A

Utilization Guidelines
N/A

Sources of Information and Basis for Decision

   1.  Practice Guidelines - American Academy of Environmental Medicine

   2.  Homeopathy Publication - Natural Medicine for the 21st Century by
       National Center for Homeopathy - 1993

   3.  Article from Journal of Allergy and Clinical Immunology, Vol 67, No.5,
       May 1981, pg. 333-338

   4.  Medical Director

   5.  Carrier Medicare Manual - Health Care Financing Administration

   6.  Medicare's Coverage Issues Manual - Health Care Financing
       Administration

   7.  Micro Medicine by Diane Debrovner - 36  June 1993 - American Druggist

   8.  Technology Advisory Committee Meeting - October 5-6, 1993

   9.  Clinical Ecology - Council on Scientific Affairs - JAMA December
       23/30, 1992 - Vol. 268, No. 24

Start Date of Comment Period
09/05/1995

End Date of Comment Period
10/20/1995

Start Date of Notice Period
11/01/1995

Revision History Number
1

Revision History Explanation
This LCD is end dated because it is no longer an effective education tool.

Revision #1: Converted the LMRP to LCD. No Coding Guideline article ­ N/A. Added new information regarding noncoverage of acupuncture for fibromyalgia and osteoarthritis.

This LCD was converted from an LMRP on 7/14/2004