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INDEX:
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Effective Date: 05/21/2004 Title: Acupuncture
Revision Date: 08/23/2011 Document: BI034:00
CPT Code(s): 97810-97811, 97813-97814
Public Statement

Effective Date:

a)    This policy will apply to all services performed on or after the above revision date which will become the new effective date.

b)    For all services referred to in this policy that were performed before the revision date, contact customer service for the rules that would apply.

Acupuncture and acupressure are not covered benefits under policies issued by QualChoice/QCA.  The scientific evidence regarding the effectiveness of acupuncture is conflicting and generally insufficient to establish its validity.


Medical Statement

Acupuncture is not a generally accepted procedure for treatment of injury or disease and is not as yet accepted by mainstream practitioners.  Acupuncture is considered as Alternative or Complimentary Medicine and should be denied for coverage as benefit exclusion.

 

Codes Used In This BI:

97810 Acupuncture w/o stimul 15 min
97811 Acupuncture w/o stimul addl 15m
97813 Acupuncture w/stimul 15 min
97814 Acupuncture w/stimul addl 15m
 


Limits

Not a covered benefit.


Reference

HCFA Coverage Issues Manual, Medical Procedures, #35-8 Acupuncture, page 5.  http://www.hcfa.gov/pubforms/06-cim/ci35.htm

 

Hayes Manual

 

Hayes: Acupuncture and Acupressure for the Treatment of Nausea and Vomiting; Nov 2001

Hayes: Acupuncture for Addictive Behavior; Nov 2001

Hayes: Acupuncture for the Treatment of Pain; Aug 2001

Hayes Alert, Vol VII, Number 4 – April 2004: Acupuncture for Chronic Headache

 

February 2003 National Coverage Determination brief:  Medicare is not covering acupuncture for  fibromyalgia, nausea after chemo, post operative pain, or osteoarthritis.

 

NIH is assessing the use for surgical anesthesia and chronic pain management, but Medicare is not paying for acupuncture until these studies are complete and efficacy has been established.


Application to Products
This policy applies to all health plans administered by QualChoice, both those insured by QualChoice and those that are self-funded by the sponsoring employer, unless there is indication in this policy otherwise or a stated exclusion in your medical plan booklet. Consult the individual plan sponsor Summary Plan Description (SPD) for self-insured plans or the specific Evidence of Coverage (EOC) for those plans insured by QualChoice. In the event of a discrepancy between this policy and a self-insured customer’s SPD or the specific QualChoice EOC, the SPD or EOC, as applicable, will prevail. State and federal mandates will be followed as they apply.
Changes: QualChoice reserves the right to alter, amend, change or supplement benefit interpretations as needed.
This policy has recently been updated. Please use the index above or enter policy title in search bar for the latest version.