New York Medicaid Stops Paying For Chronic Back Pain Procedures

The New York State Medicaid Program announced in its official publication that the NY Medicaid program will no longer cover certain treatments for chronic low back pain. The change is effective immediately for Medicaid fee-for-service beneficiaries and effective June 1, 2012, for Medicaid managed care and Family Health Plus (FHPlus) enrollees. NY Medicaid will no longer reimburse the following procedures:

  • Prolotherapy;
  • Systemic corticosteroids;
  • Therapeutic facet joint steroid injections in the lumbar and sacral regions eith or without CT or fluoroscopic image guidance;o Injections of steroids into intervertebral discs;
  • Continuous or intermittent traction.

Medicaid now considers these procedures ineffective, or experimental and investigational.

Medicaid, however, will continue to cover:

  • Pharmaceuticals (prescription and non-prescription) to reduce pain; and
  • Practitioner-ordered physical therapy for treatment of back pain.

If you have questions about the New York Medicaid reimbursement policies or need legal assistance, please contact us.