INSURANCE COVERAGE GUIDELINES FOR ACUPUNCTURE
Policy:
Coverage is subject to the terms, conditions, and limitations of the member's contract.
The provision of benefits for all services related to acupuncture is in accordance with the individual's benefit contract and varies by insurance company, product and group. Therefore, individual member benefits must be verified. Coverage of acupuncture may be subject to coverage limits, existing contractual exclusions, and medical necessity criteria.
MEDICALLY NECESSARY (More likely covered by Insurance Providers)
Needle acupuncture (manual or with electrical stimulation) is considered medically necessary for the following conditions (to be verified with your individual plan, provider and/or acupuncturist):
Headache (migraine and tension)
Postoperative nausea and vomiting
Chemotherapy-induced nausea and vomiting
Nausea of pregnancy
Low back pain
Chronic neck pain
Pain from osteoarthritis of the knee and hip
Some plans (Aetna) may cover musculoskeletal joint and soft tissue pain (e.g., hip, knee, spine) resulting in a functional deficit (e.g., inability to perform household chores, interference with job functions, loss of range of motion)
Some plans (Aetna) may cover post-operative dental pain
Some plans (Aetna) may cover temporomandibular disorders (TMD)
NOT MEDICALLY NECESSARY (Most likely NOT covered by Insurance Providers)
Acupuncture for all other uses is considered “experimental/investigational because there is inadequate scientific research assessing the efficacy of acupuncture compared with placebo, sham acupuncture or other modalities.” The treatment of the following conditions with acupuncture are considered “not medically necessary” and are not covered by insurance (this list is not all inclusive):
Abdominal obesity
Acne
Acute pancreatitis
Addiction
AIDS
Alcohol withdrawal syndrome
Allergies
Alzheimer’s disease
Amblyopia
Anorexia
Asthma
Attention deficit hyperactivity disorder (ADHD)
Autism spectrum disorders
Bell's palsy
Benign prostatic hypertrophy
Breast cancer-related hot flashes
Breast cancer-related lymphedema
Burning mouth syndrome
Cancer-induced bone pain
Cancer-related dyspnea
Cancer-related fatigue
Cardiovascular diseases (e.g., angina pectoris, heart failure, hypertension)
Carpal tunnel syndrome
Cerebral palsy
Chemotherapy-induced leukopenia
Chemotherapy-induced neuropathic pain
Chronic hepatitis B
Chronic ankle instability
Chronic pain syndrome (e.g., RSD, facial pain)
Chronic obstructive pulmonary disease (COPD)
Chronic constipation
Chronic fatigue syndrome
Cognitive impairment
Coronary heart disease
Diabetic gastroparesis
Diabetic peripheral neuropathy
Diminished ovarian reserve
Dry eyes
Dysmenorrhea
Endometriosis pain
Epilepsy
Erectile dysfunction
Facial spasm
Fetal breech presentation
Fibromyalgia
Fibrotic contractures
Gastric ulcer
Glaucoma
Gout
Hypoxic ischemic encephalopathy
Induction of labor
Infantile colic
Infantile diarrhea
Infertility (e.g., to assist oocyte retrieval and embryo transfer during IVF treatment cycle)
Inflammatory bowel diseases (Crohn's disease and ulcerative colitis)
Insomnia (including cancer-related insomnia)
Intra-cerebral hemorrhage
Irritable bowel syndrome
Menopause-associated vasomotor symptoms
Menopausal hot flashes
Menstrual cramps/dysmenorrhea
Mild cognitive impairment
Multiple sclerosis
Mumps
Myofascial pain
Myopia
Neuropathic pain
Nocturnal enuresis
Non-alcoholic fatty liver disease
Obesity / weight reduction
Obstructive sleep apnea
Occipital neuralgia
Oligoasthenozoospermia
Oral ulcer
Osteoporosis
Painful neuropathies
Parkinson's disease
Parkinson's disease-related fatigue, depression
Peptic ulcer
Peripheral arterial disease (e.g., intermittent claudication)
Phantom leg pain
Plantar fasciitis
Polycystic ovary syndrome
Post-herpetic neuralgia
Post-operative ileus
Post-prandial distress syndrome
Post-stroke hiccup
Post-stroke shoulder pain
Post-surgical neuropathic pain after breast cancer surgery
Post-traumatic stress disorder
Premature ejaculation
Premenstrual syndrome/premenstrual dysphoric disorder
Pruritus
Psoriasis
Psychiatric disorders (e.g., anxiety, depression, and schizophrenia)
Raynaud’s disease pain
Renal colic
Respiratory disorders
Restless leg syndrome
Rheumatoid arthritis
Rhinitis
Sensorineural deafness
Sexual dysfunction
Shoulder bursitis
Sleep disturbance in individuals with cancer
Smoking cessation
Spasticity after stroke
Stroke rehabilitation (e.g., dysphagia)
Systemic lupus erythematosus
Tennis elbow / epicondylitis
Thoracic back pain
Tic disorders (e.g., Tourette syndrome)
Tinnitus
Urinary incontinence
Uterine fibroids
Vascular dementia
Xerostomia
Whiplash
REQUIRED DOCUMENTATION
The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the professional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.