Humana Commercial Clinical Policy

Humana Acupuncture Form

Effective Date

12/14/2023

Last Reviewed

NA

Original Document

  Reference



Description

Acupuncture is a technique of inserting and manipulating very fine needles into the skin to stimulate specific anatomic points in the body (also known as acupoints or acupuncture points) for therapeutic purposes. Acupuncture may be considered a treatment option for various health conditions.

For information regarding acupuncture for allergies, please refer to Allergy Treatments Medical Coverage Policy.

Any state mandates for acupuncture take precedence over this medical coverage policy.

Coverage Determination

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Acupuncture Effective Date: 12/14/2023
Revision Date: 12/14/2023
Review Date: 12/14/2023
Policy Number: HUM-0373-018

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Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

Acupuncture may be excluded by certificate. Please consult the member’s individual certificate regarding Plan coverage.

Humana members may be eligible under the Plan for acupuncture when the following criteria are met:

  • Must be ordered by a physician or other licensed health care practitioner and performed by a duly licensed and certified, if applicable, acupuncturist. All services provided must be within the applicable scope of practice for the provider in their licensed jurisdiction where the services are provided, AND
  • any of the following:
    • Cancer-related pain; OR
    • Chronic (minimum of 12 consecutive weeks duration) headaches; OR
    • Chronic (minimum of 12 consecutive weeks duration) low back or neck pain; OR
    • Nausea and vomiting associated with chemotherapy, postoperative or pregnancy; OR
    • Osteoarthritis of the knee

Commercial Plan members: treatments beyond 5 visits without improvement require review by a medical director.

Note: The criteria for acupuncture are not consistent with the Medicare National Coverage Policy and therefore may not be applicable to Medicare members. Refer to the CMS website for additional information.

Coverage Limitations

Humana members may NOT be eligible under the Plan for acupuncture for any indications other than those listed above including, but may not be limited to:

  • Addiction/substance abuse disorder; OR
  • Anesthesia for procedures/surgery; OR

Acupuncture Effective Date: 12/14/2023
Revision Date: 12/14/2023
Review Date: 12/14/2023
Policy Number: HUM-0373-018

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Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

  • Asthma; OR
  • Chronic obstructive pulmonary disease (COPD); OR
  • Diabetic neuropathy; OR
  • Dysmenorrhea; OR
  • Endometriosis pain; OR
  • Epicondylitis; OR
  • Fibromyalgia; OR
  • Infantile colic; OR
  • Infertility; OR
  • Insomnia; OR
  • Menopausal hot flashes; OR
  • Mental health conditions (eg, anxiety/panic disorder, depression); OR
  • Obesity/weight reduction; OR
  • Smoking cessation; OR
  • Temporomandibular joint disorders; OR
  • Tinnitus

This is considered experimental/investigational as it is not identified as widely used and generally accepted for any other proposed use as reported in nationally recognized peer-reviewed medical literature published in the English language.

Humana members may NOT be eligible under the Plan for acupuncture for maintenance care, which occurs when therapeutic goals of the treatment program are achieved or when no further significant progress is made or reasonably seen as occurring as this is generally excluded in the certificate. In the absence of a certificate exclusion for maintenance care, it would be considered not medically necessary as defined in the member’s individual certificate.

Background

Please refer to the member’s individual certificate for the specific definition.

Additional information about back pain, headaches, nausea and vomiting (postoperative, pregnancy related or chemotherapy induced) and osteoarthritis may be found from the following websites:
  • American Academy of Orthopaedic Surgeons
  • American College of Physicians
  • American Society of Anesthesiologists

Acupuncture Effective Date: 12/14/2023
Revision Date: 12/14/2023
Review Date: 12/14/2023
Policy Number: HUM-0373-018
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Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

  • National Headache Foundation
  • National Institute of Neurological Disorders and Stroke
  • National Library of Medicine
Medical Alternatives

Alternatives to acupuncture include, but may not be limited to, the following:

  • Chiropractic treatment (please refer to Chiropractic Care Medical Coverage Policy)
  • Physical therapy (please refer to Physical Therapy and Occupational Therapy Medical Coverage Policy)
  • Prescription drug therapy

Physician consultation is advised to make an informed decision based on an individual’s health needs.

Any CPT, HCPCS or ICD codes listed on this medical coverage policy are for informational purposes only. Do not rely on the accuracy and inclusion of specific codes. Inclusion of a code does not guarantee coverage and or reimbursement for a service or procedure.

CPT® Code(s)

97810 Acupuncture, 1 or more needles; without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient

97811 Acupuncture, 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)

97813 Acupuncture, 1 or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient

Acupuncture Effective Date: 12/14/2023
Revision Date: 12/14/2023
Review Date: 12/14/2023
Policy Number: HUM-0373-018
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Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

97814

Acupuncture, 1 or more needles; with electrical stimulation, additional 15 minutes of personal one-on-one contact the patient, with re-insertion of needle(s) (List separately addition to code for primary procedure)

References
  • American Academy of Orthopaedic Surgeons (AAOS). Evidence-Based Clinical Practice Guideline. Management of osteoarthritis of the knee (non-arthroplasty). https://www.aaos.org. Published August 31, 2021. Accessed November 15, 2023.
  • American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS). Clinical practice guideline: tinnitus. https://www.entnet.org. Published 2014. Accessed November 15, 2023.
  • American College of Obstetricians and Gynecologists (ACOG). Practice Bulletin. Management of menopausal symptoms. https://www.acog.org. Published January 2014.
  • American College of Obstetricians and Gynecologists (ACOG). Practice Bulletin. Nausea and vomiting of pregnancy. https://www.acog.org. Published January 2018. Updated 2021. Accessed November 15, 2023.
  • American College of Physicians (ACP). Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. https://www.acponline.org. Published April 4, 2017. Accessed November 15, 2023.
  • American Psychiatric Association (APA). Practice guideline for the treatment of patients with major depressive disorder. 3rd edition. https://www.psychiatry.org. Published October 2010. Accessed November 15, 2023.
  • American Psychiatric Association (APA). Practice guideline for the treatment of patients with panic disorder. 2nd edition. https://www.psychiatry.org. Published January 2009. Accessed November 15, 2023.
  • American Psychiatric Association (APA). Practice guideline for the treatment of patients with substance use disorders. 2nd edition. https://www.psychiatry.org. Published August 2006. Accessed November 15, 2023.
  • American Society of Clinical Oncology (ASCO). Integrative medicine for pain management in oncology: Society for Integrative Oncology-ASCO guideline. https://www.asco.org. Published September 13, 2022. Accessed November 15, 2023.
  • American Society of Clinical Oncology (ASCO). Integrative therapies during and after breast cancer treatment: ASCO endorsement of the SIO clinical practice guideline. https://www.asco.org. Published June 7, 2018. Accessed November 15, 2023.
  • Centers for Medicare & Medicaid Services (CMS). National Coverage Determination (NCD). Acupuncture (30.3). https://www.cms.gov. Published January 1, 1966. Updated January 21, 2020. Accessed November 15, 2023.
  • Centers for Medicare & Medicaid Services (CMS). National Coverage Determination (NCD). Acupuncture for chronic low back pain (cLBP) (30.3.3). https://www.cms.gov. Published January 21, 2020. Accessed November 15, 2023.
  • Centers for Medicare & Medicaid Services (CMS). National Coverage Determination (NCD). Acupuncture for fibromyalgia (30.3.1). https://www.cms.gov. Published April 16, 2004. Updated January 21, 2020. Accessed November 15, 2023.
  • Centers for Medicare & Medicaid Services (CMS). National Coverage Determination (NCD). Acupuncture for osteoarthritis (30.3.2). https://www.cms.gov. Published April 16, 2004. Updated January 21, 2020. Accessed November 15, 2023.
  • ECRI Institute. Hotline Response (ARCHIVED). Acupuncture for treating chronic pain. https://www.ecri.org. Published June 8, 2017. Accessed November 13, 2023.
  • Hayes, Inc. Evidence Analysis Research Brief. Acupuncture for treatment of dysmenorrhea. https://evidence.hayesinc.com. Published June 21, 2023. Accessed November 13, 2023.
  • Hayes, Inc. Evidence Analysis Research Brief. Acupuncture for treatment of temporomandibular disorders. https://evidence.hayesinc.com. Published June 8, 2023. Accessed November 13, 2023.
  • Hayes, Inc. Health Technology Brief. Acupuncture for treatment of chronic obstructive pulmonary disease (COPD). https://evidence.hayesinc.com. Accessed November 13, 2023.

Acupuncture Effective Date: 12/14/2023
Revision Date: 12/14/2023
Review Date: 12/14/2023
Policy Number: HUM-0373-018
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Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

  • Hayes, Inc. Medical Technology Directory. Acupuncture for assisted reproduction. https://evidence.hayesinc.com. Published July 15, 2011. Updated June 5, 2015. Accessed November 13, 2023.
  • Hayes, Inc. Medical Technology Directory. Acupuncture for the prevention or treatment of nausea and vomiting: a review of reviews. https://evidence.hayesinc.com. Published September 19, 2018. Updated September 28, 2022. Accessed November 13, 2023.
  • Hayes, Inc. Medical Technology Directory. Acupuncture for the treatment of pain. https://evidence.hayesinc.com. Published January 20, 2005. Updated March 29, 2009. Accessed November 13, 2023.
  • Hayes, Inc. Medical Technology Directory. Acupuncture for the treatment of shoulder pain or chronic neck pain: a review of reviews.https://evidence.hayesinc.com. Published August 22, 2018. Updated August 18, 2022. Accessed November 13, 2023.
  • Hayes, Inc. Medical Technology Directory. Acupuncture for treatment of addictive behavior. https://evidence.hayesinc.com. Published May 31, 2005. Updated May 20, 2009. Accessed November 13, 2023.
  • Hayes, Inc. Medical Technology Directory. Acupuncture for treatment of fibromyalgia. https://evidence.hayesinc.com. Published August 28, 2018. Updated August 19, 2022. Accessed November 13, 2023.
  • Hayes, Inc. Medical Technology Directory. Acupuncture for treatment of postoperative pain: a review of reviews. https://evidence.hayesinc.com. Published May 25, 2018. Updated May 11, 2022. Accessed November 13, 2023.
  • Hayes, Inc. Medical Technology Directory. Comparative effectiveness review of acupuncture for the treatment of chronic low back pain: a review of reviews. https://evidence.hayesinc.com. Published June 28, 2018. Updated June 10, 2022. Accessed November 13, 2023.
  • Hayes, Inc. Medical Technology Directory. Comparative effectiveness review of acupuncture for the treatment of episodic and chronic tension type headache and episodic migraine: a review of reviews. https://evidence.hayesinc.com. Published September 10, 2018. Updated September 21, 2022. Accessed November 13, 2023.
  • Hayes, Inc. Medical Technology Directory. Comparative effectiveness review of acupuncture for the treatment of knee osteoarthritis: review of reviews. https://evidence.hayesinc.com. Published July 24, 2018. Updated July 22, 2022. Accessed November 13, 2023.
  • Hayes, Inc. Medical Technology Directory. Comparative effectiveness review of acupuncture for the treatment of substance use disorders: a review of reviews. https://evidence.hayesinc.com. Published June 26, 2018. Updated June 23, 2022. Accessed November 13, 2023.
  • MCG Health. Acupuncture. 27th edition. https://www.mcg.com. Accessed October 17, 2023.
  • National Center for Complementary and Integrative Health (NCCIH). Acupuncture: what you need to know. https://www.nccih.nih.gov. Published October 2022. Accessed November 15, 2023.
  • National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology. Adult cancer pain. https://www.nccn.org. Published July 31, 2023. Accessed November 15, 2023.

Acupuncture Effective Date: 12/14/2023
Revision Date: 12/14/2023
Review Date: 12/14/2023
Policy Number: HUM-0373-018
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Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

  • National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology. Antiemesis. https://www.nccn.org. Published May 24, 2023. Accessed November 15, 2023.
  • National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology. Palliative care. https://www.nccn.org. Published April 24, 2023. Accessed November 15, 2023.
  • National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology. Smoking cessation. https://www.nccn.org. Published September 15, 2023. Accessed November 15, 2023.
  • UpToDate, Inc. Approach to the management of chronic non-cancer pain in adults. https://www.uptodate.com. Updated October 2023. Accessed November 13, 2023.
  • UpToDate, Inc. Chronic pelvic pain in adult females: treatment. https://www.uptodate.com. Updated October 2023. Accessed November 13, 2023.
  • UpToDate, Inc. Complementary, alternative and integrative therapies for asthma. https://www.uptodate.com. Updated October 2023. Accessed November 13, 2023.

Acupuncture Effective Date: 12/14/2023
Revision Date: 12/14/2023
Review Date: 12/14/2023
Policy Number: HUM-0373-018
Page: 10 of 13

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

  • UpToDate, Inc. Complementary and integrative health in pediatrics. https://www.uptodate.com. Updated October 2023. Accessed November 13, 2023.
  • UpToDate, Inc. Dysmenorrhea in adult females: treatment. https://www.uptodate.com. Updated October 2023. Accessed November 13, 2023.
  • UpToDate, Inc. Elbow tendinopathy (tennis and golf elbow). https://www.uptodate.com. Updated October 2023. Accessed November 13, 2023.
  • UpToDate, Inc. Infantile colic: management and outcomes. https://www.uptodate.com. Updated November 7, 2023. Accessed November 13, 2023.
  • UpToDate, Inc. Management of non-radicular neck pain in adults. https://www.uptodate.com. Updated October 4, 2023. Accessed November 13, 2023.
  • UpToDate, Inc. Management of poorly controlled or breakthrough chemotherapy-induced nausea and vomiting in adults. https://www.uptodate.com. Updated October 2023. Accessed November 13, 2023.
  • UpToDate, Inc. Menopausal hot flashes. https://www.uptodate.com. Updated October 2023. Accessed November 13, 2023.
  • UpToDate, Inc. Myofascial pelvic pain syndrome in females: treatment. https://www.uptodate.com. Updated October 2023. Accessed November 13, 2023.
  • UpToDate, Inc. Nausea and vomiting of pregnancy: treatment and outcome. https://www.uptodate.com. Updated October 2023. Accessed November 13, 2023.

Acupuncture Effective Date: 12/14/2023
Revision Date: 12/14/2023
Review Date: 12/14/2023
Policy Number: HUM-0373-018
Page: 11 of 13

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

  • UpToDate, Inc. Nonpharmacological approaches to management of labor pain. https://www.uptodate.com. Updated October 2023. Accessed November 13, 2023.
  • UpToDate, Inc. Obesity in adults: overview of management. https://www.uptodate.com. Updated October 2023. Accessed November 13, 2023.
  • UpToDate, Inc. Overview of complementary, alternative, and integrative medicine practices in oncology care, and potential risks and harm. https://www.uptodate.com. Updated October 2023. Accessed November 13, 2023.
  • UpToDate, Inc. Overview of smoking cessation management in adults. https://www.uptodate.com. Updated October 2023. Accessed November 13, 2023.
  • UpToDate, Inc. Overview of the clinical uses of acupuncture. https://www.uptodate.com. Updated October 2023. Accessed November 13, 2023.

Acupuncture Effective Date: 12/14/2023
Revision Date: 12/14/2023
Review Date: 12/14/2023
Policy Number: HUM-0373-018
Page: 12 of 13

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

  • UpToDate, Inc. Overview of the management of overuse (persistent) tendinopathy. https://www.uptodate.com. Updated November 9, 2023. Accessed November 13, 2023.
  • UpToDate, Inc. Postoperative nausea and vomiting. https://www.uptodate.com. Updated November 8, 2023. Accessed November 13, 2023.
  • UpToDate, Inc. Preventive treatment of episodic migraine in adults. https://www.uptodate.com. Updated October 2023. Accessed November 13, 2023.
  • UpToDate, Inc. Subacute and chronic low back pain: nonpharmacologic and pharmacologic treatment. https://www.uptodate.com Updated October 2023. Accessed November 13, 2023.

Acupuncture Effective Date: 12/14/2023
Revision Date: 12/14/2023
Review Date: 12/14/2023
Policy Number: HUM-0373-018
Page: 12 of 13

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

  • UpToDate, Inc. Tension-type headache in adults: preventive treatment. https://www.uptodate.com. Updated October 2023. Accessed November 13, 2023.
  • UpToDate, Inc. Treatment of acute low back pain. https://www.uptodate.com. Updated October 2023. Accessed November 13, 2023.
  • UpToDate, Inc. Treatment of fibromyalgia in adults not responsive to initial therapies. https://www.uptodate.com. Updated October 2023. Accessed November 13, 2023.
  • UpToDate, Inc. Treatment of tinnitus. https://www.uptodate.com. Updated October 2023. Accessed November 13, 2023.
  • US Department of Veterans Affairs (VA). VA/DoD Clinical Practice Guideline. Diagnosis and treatment of low back pain. https://www.va.gov. Published February 2022. Accessed November 15, 2023.
  • US Department of Veterans Affairs (VA). VA/DoD Clinical Practice Guideline. Management of chronic multisymptom illness. https://www.va.gov. Published May 2021. Accessed November 15, 2023.
  • US Department of Veterans Affairs (VA). VA/DoD Clinical Practice Guideline. Management of first-episode psychosis and schizophrenia. https://www.va.gov. Published April 2023. Accessed November 15, 2023.
  • US Department of Veterans Affairs (VA). VA/DoD Clinical Practice Guideline. Management of headache. https://www.va.gov. Published September 2023. Accessed November 15, 2023.
  • US Department of Veterans Affairs (VA). VA/DoD Clinical Practice Guideline. Management of major depressive disorder. https://www.va.gov. Published February 2022. Accessed November 15, 2023.
  • US Department of Veterans Affairs (VA). VA/DoD Clinical Practice Guideline. Management of posttraumatic stress disorder and acute stress disorder. https://www.va.gov. Published June 2023. Accessed November 15, 2023.

Acupuncture Effective Date: 12/14/2023
Revision Date: 12/14/2023
Review Date: 12/14/2023
Policy Number: HUM-0373-018
Page: 13 of 13

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

  • US Department of Veterans Affairs (VA). VA/DoD Clinical Practice Guideline. Non-surgical management of hip & knee osteoarthritis. https://www.va.gov. Published July 2020. Accessed November 15, 2023.