Coverage Policy Manual
Policy #: 1998011
Category: Alternative Medicine
Initiated: January 1993
Last Review: August 2018
  Acupuncture

Description:
Acupuncture is a traditional form of Chinese medical treatment that has been practiced for over 3,000 years.
 
Acupuncture is the practice of piercing the skin with needles at specific body sites to induce anesthesia, to relieve pain, to alleviate withdrawal symptoms of substance abusers, or to treat various non-painful disorders.  In acupuncture, the placement of needles into the skin is dictated by the location of meridians.  These meridians are thought to mark patterns of energy flow throughout the human body.  Acupuncture has four components - the acupuncture needle(s), the target location defined by traditional Chinese medicine, the depth of insertion, and the stimulation of the inserted needle.
 
Electroacupuncture, or transcutaneous electrical nerve stimulation (TENS) acupuncture, is the practice of piercing specific body sites with needles that are stimulated by an extremely low voltage of electricity.

Policy/
Coverage:
Any form of acupuncture, including acupuncture for the treatment of pain, is not covered due to an exclusion in the member certificate of coverage.
 
For member benefit certificates without this specific exclusion, acupuncture may be considered medically necessary for treatment of nausea associated with surgery, chemotherapy, and pregnancy.
 
For member benefit certificates without this specific exclusion, acupuncture for any other indication, including but not limited to acupuncture for the treatment of pain, is considered investigational.
 

Rationale:
2014 Update
 A literature search conducted through July 2014 did not reveal any new information that would prompt a change in the coverage statement.
 
2018 Update
Annual policy review completed with a literature search using the MEDLINE database through June 2018. No new literature was identified that would prompt a change in the coverage statement.
 

CPT/HCPCS:
97810Acupuncture, 1 or more needles; without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
97811Acupuncture, 1 or more needles; without electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (List separately in addition to code for primary procedure)
97813Acupuncture, 1 or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
97814Acupuncture, 1 or more needles; with electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (List separately in addition to code for primary procedure)

References: Haake M, Hans-Helge M, et al.(2007) German Acupuncture Trials (GERAC) for chronic low back pain. Arch Intern Med, 2007; 167:1892-8.


Group specific policy will supersede this policy when applicable. This policy does not apply to the Wal-Mart Associates Group Health Plan participants or to the Tyson Group Health Plan participants.
CPT Codes Copyright © 2019 American Medical Association.