Coverage for acupuncture is determined according to individual or group customer benefits. When a covered benefit, acupuncture (97810-97814) is covered for treatment of the following conditions:

• Nausea associated with surgery, chemotherapy, and pregnancy;
• Chronic low back pain;
• Chronic headache or migraine headache.

Acupuncture for any other indication or condition, including but not limited to acupuncture for the treatment of pain, is considered experimental/investigational, and therefore non-covered. There is inadequate evidence in peer-reviewed medical literature to support the efficacy of acupuncture for the treatment of pain. A participating, preferred, or network provider can bill the member for the non-covered service.

NOTE:

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.

Acupuncture is eligible in accordance with the following requirements:

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

For services provided on or after 1/1/06, acupuncture is covered when performed by a licensed acupuncturist.

Heazell A, Thorneycroft J, Walton V, Etherington I. Acupressure for the in-patient treatment of nausea and vomiting in early pregnancy: a randomized control trial. Am J Obstet Gynecol. 2006 Mar;194(3):815-20.

Sun Y, Gan TJ. Acupuncture for the management of chronic headache: a systematic review. Anesth Analg. 2008 Dec; 107(6):2038-47.

Sun Y, Gan TJ, Dubose JW, Habib AS. Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials. BR J Anaesth. 2008 Aug;101(2):151-60.

Ma L. Acupuncture as a complementary therapy in chemotherapy-induced nausea and vomiting. Proc (Bayl Univ Med Cent). 2009 Apr;22(2):138-41.

Frey UH, Scharmann P. Lohlein C, Peters J. P6 acustimulation effectively decreases postoperative nausea and vomiting in high-risk patients. Br J Anaesth. 2009 May;102(5):620-5.

Guirguis-Blake J. Effectiveness of acupuncture for migraine prophylaxis. Am Fam Physician. 2010 Jan 1;81(1):29.

Rubinstein SM, van Middelkoop M, Kuijpers T, Ostelo R, Verhagen AP, Verhagen AP, de Boer MR, Koes BW, van Tulder MW. A systematic review on the effectiveness of complementary and alternative medicine for chronic non-specific low-back pain. Eur Spine J. 2010 Aug;19(8):1213-1228.