Acupuncture
Does not apply to Medicare Advantage and Commercial claims.
Applies only to BlueCare and CoverKids.
DESCRIPTION
Acupuncture is a traditional form of Chinese medical treatment that has been practiced for over 3,000 years. Acupuncture involves piercing the skin with needles at specific body sites to relieve pain or to treat various non-painful disorders (e.g., to relieve nausea/vomiting). In traditional 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. The technology has four components – the acupuncture needle(s), the target location or meridian as defined by traditional Chinese medicine, the depth of insertion, and the manual stimulation of the inserted needle.
Electroacupuncture (i.e., transcutaneous electrical nerve stimulation acupuncture) is the practice of piercing specific body sites with needles that are stimulated by an extremely low voltage of electricity.
POLICY
Acupuncture, manual or electro-acupuncture, may be considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
Acupuncture, manual or electro-acupuncture, is considered investigational as a treatment for all other conditions/disorders including, but not limited to, opioid reduction or cessation in opiate users.
MEDICAL APPROPRIATENESS
Acupuncture is considered medically appropriate if documentation shows ANY ONE of the following:
Episodic migraines and/or severe tension type headaches
Nausea due to ANY ONE of the following:
Pregnancy
Chemotherapy
Surgery
Acute or chronic low back pain with ALL of the following:
No severe or progressive neurologic deficits
Pain not due to cancer, infection, inflammatory arthropathy, high-velocity trauma, or fracture
IMPORTANT REMINDERS
Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g. statement.
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits, or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan or government program (e.g., TennCare), the express terms of the health plan or government program will govern.
Does not apply to Medicare Advantage and Commercial claims.
Applies only to BlueCare and CoverKids.
SOURCES
Agency for Healthcare Research and Quality. (2020, April). Noninvasive nonpharmacological treatment for chronic pain: a systematic review update. Retrieved November 18, 2021 from http://www.ahrq.gov/.
American Academy of Orthopaedic Surgeons. (2021, August). American Academy of Orthopaedic Surgeons clinical practice guideline on the management of osteoarthritis of the knee (non-arthroplasty), 3rd edition. Retrieved January 4, 2023 from www.aaos.com.
American College of Physicians. (2017, April). Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline. Annals of Internal Medicine, 166, 514-530.
BlueCross BlueShield Association. Evidence Positioning System. (2023, December). Acupuncture for pain management, nausea and vomiting, and opioid dependence (7.01.157). Retrieved January 30, 2024 from https://www.evidencepositioningsystem.com/. (48 articles and/or guidelines reviewed).
Centers for Medicare & Medicaid Services. CMS.gov. National Coverage Determination (NCD) for Acupuncture for chronic low back pain (cLBP) (30.3.3). Retrieved February 18, 2021 from https://www.cms.gov.
Centers for Medicare & Medicaid Services. CMS.gov. National Coverage Determination (NCD) Acupuncture. (30.3). Retrieved January 30, 2024 from https://www.cms.gov.
Eccleston, C., Fisher, E., Thomas, K. H., Hearn, L., Derry, S., Stannard, C., et al. (2017). Interventions for the reduction of prescribed opioid use in chronic non-cancer pain. The Cochrane Database of Systematic Reviews, 11 (11), CD010323, doi: 10.1002/14651858.CD010323.pub3. (Level 2 evidence)
Li, Y., Zheng, H., Witt, C., Roll, S., Yu, S., Yan, J., et al. (2012). Acupuncture for migraine prophylaxis: a randomized controlled trial. Canadian Medical Association Journal, 184 (4), 401-410. (Level 1 evidence)
Mao, J.J., Ismaila, N., Ting, B., Barton, D., Ben-Arye, E., Garland, E.L., et al. (2022). Integrative medicine for pain management in oncology: society for integrative oncology-asco guideline. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 40 (34), 3998-4024. (Level 2 evidence)
National Institute for Health and Care Excellence (2012, September; Last update search May 2021). Clinical guideline: Headaches in over 12s: diagnosis and management. Retrieved November 18, 2021 from www.nice.org.uk.
National Institute for Health and Care Excellence (2014, February; last update search October 2022). Clinical guideline: Osteoarthritis in over 16s: diagnosis and management. Retrieved January 6, 2023 from www.nice.org.uk.
National Institute for Health and Care Excellence (2016, November; last update search December 2020). Clinical guideline: Low back pain and sciatica in over 16s: assessment and management. Retrieved November 18, 2021 from www.nice.org.uk.
Park, J., Hahn, S., Park, J-Y., & Lee, H. (2013). Acupuncture for ankle sprain: systematic review and meta-analysis. BMC Complementary and Alternative Medicine, 13 (55). (Level 1 evidence)
Wen, H., Chen, R., Zhang, P., Wei, X., Dong, Y., Ge, S., et al. (2021). Acupuncture for opioid dependence patients receiving methadone maintenance treatment: A network meta-analysis. Frontiers in Psychiatry, 12, 767613, doi: 10.3389/fpsyt.2021.767613. (Level 2 evidence)
Winifred S. Hayes, Inc. Comparative Effectiveness Review. (2018, June; last update search June 2022). Acupuncture for the treatment of substance use disorders: a review of reviews. Retrieved January 4, 2023 from https://www.Hayesinc.com/subscribers. (79 articles and/or guidelines reviewed)
Winifred S. Hayes, Inc. Medical Technology Directory. (2018, August; last update search August 2022). Acupuncture for the treatment of shoulder pain or chronic neck pain: a review of reviews. Retrieved January 4, 2023 from https://www.Hayesinc.com/subscribers. (90 articles and/or guidelines reviewed)
Winifred S. Hayes, Inc. Medical Technology Directory. (2018, August; last update search December 2022). Acupuncture for treatment of fibromyalgia. Retrieved January 4, 2023 from https://www.Hayesinc.com/subscribers. (41 articles and/or guidelines reviewed)
Winifred S. Hayes, Inc. Medical Technology Directory. (2018, July; last update search July 2022). Acupuncture for the treatment of knee osteoarthritis: review of reviews. Retrieved January 4, 2023 from https://www.Hayesinc.com/subscribers. (86 articles and/or guidelines reviewed)
Winifred S. Hayes, Inc. Medical Technology Directory. (2018, June; last update search June 2022). Acupuncture for the treatment of chronic lower back pain: a review of reviews. Retrieved January 4, 2023 from https://www.Hayesinc.com/subscribers. (80 articles and/or guidelines reviewed)
Winifred S. Hayes, Inc. Medical Technology Directory. (2018, May; last update search May 2022). Acupuncture for treatment of postoperative pain: a review of reviews. Retrieved January 4, 2023 from https://www.Hayesinc.com/subscribers. (77 articles and/or guidelines reviewed)
Winifred S. Hayes, Inc. Medical Technology Directory. (2018, September; last update search September 2022). Acupuncture for the treatment of episodic and chronic tension-type headache and episodic migraine: a review of reviews. Retrieved January 4, 2023 from https://www.Hayesinc.com/subscribers. (49 articles and/or guidelines reviewed)
Winifred S. Hayes, Inc. Medical Technology Directory. (2018, September; last update search September 2022). Acupuncture for the prevention or treatment of nausea and vomiting: a review of reviews. Retrieved January 4, 2023 from https://www.Hayesinc.com/subscribers. (61 articles and/or guidelines reviewed)
Winifred S. Hayes, Inc. Medical Technology Directory. (2021, May; last update search May 2022). Acupuncture for the treatment of allergic rhinitis. Retrieved January 4, 2023 from https://www.Hayesinc.com/subscribers. (34 articles and/or guidelines reviewed)
ORIGINAL EFFECTIVE DATE: 11/24/1978
MOST RECENT REVIEW DATE: 3/14/2024
ID_BT
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
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