Mountain State Medical Policy Bulletin
Section: Miscellaneous
Number: Z-14
Topic: Acupuncture
Effective Date: August 1, 2005
Issued Date: August 1, 2005
Date Last Reviewed: 06/2005

General Policy Guidelines

Indications and Limitations of Coverage

Acupuncture (97810-97814) is not recognized as an eligible service. Coverage for acupuncture is determined according to individual or group customer benefits.

Procedure Codes

97810978119781397814  

Traditional Guidelines

Refer to General Policy Guidelines

FEP Guidelines

Acupuncture is eligible in accordance with the following requirements:

  1. Benefits may be provided for anesthesia by acupuncture if it is administered in accordance with all contract requirements concerning anesthesia (i.e., it must be ordered by the attending physician in connection with covered surgery, obstetrical procedures, or shock therapy and administered by a physician other than the attending physician or his/her assistant).


  2. When acupuncture is performed as therapy either on an inpatient or outpatient basis, medical benefits apply if the service was performed by a physician acting within the scope of his or her license and it is determined by medical review that the therapy was effective treatment. Otherwise, benefits should be denied.


    3. Note: Prior to January 1, 2004, benefits are available when acupuncture services are rendered by a physical therapist on an "exception basis only".

  3. Claims reporting supervision or medical direction of anesthesia care should be processed according to the guidelines issued in Medical Policy Bulletin A-3.

PPO Guidelines

Refer to General Policy Guidelines

Managed Care POS Guidelines

Refer to General Policy Guidelines

Publications

References

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Glossary




This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Medical policies are designed to supplement the terms of a member's contract. The member's contract defines the benefits available; therefore, medical policies should not be construed as overriding specific contract language. In the event of conflict, the contract shall govern.

Medical policies do not constitute medical advice, nor the practice of medicine. Rather, such policies are intended only to establish general guidelines for coverage and reimbursement under Mountain State Blue Cross Blue Shield plans. Application of a medical policy to determine coverage in an individual instance is not intended and shall not be construed to supercede the professional judgment of a treating provider. In all situations, the treating provider must use his/her professional judgment to provide care he/she believes to be in the best interest of the patient, and the provider and patient remain responsible for all treatment decisions.

Mountain State Blue Cross Blue Shield (MSBCBS) retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of MSBCBS. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.