Acupuncture – Minnesota Health Care Programs
These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.
Prior authorization is not required for acupuncture.
Acupuncture is generally covered, if the member has an acupuncture benefit, per the indications listed below. Due to variations in member contracts, please check with Member Services for information regarding specific coverage for this service.
Acupuncture is covered only when provided by a licensed acupuncturist or by another Minnesota licensed practitioner for whom acupuncture is within the practitioner's scope of practice and who has specific acupuncture training or credentialing.
Indications that are covered
Acupuncture is covered for the following conditions:
- Acute pain
- Chronic pain
- Post-traumatic stress disorder
- Smoking cessation
- Restless legs syndrome
- Menstrual disorders
- Xerostomia (dry mouth) associated with:
- Sjogren’s syndrome
- Radiation therapy
- Nausea and vomiting associated with:
- Post-operative procedures
- Cancer care
Items that fall within an acupuncturist scope of practice such as, breathing techniques, dietary guidelines and exercise based on Oriental principles are considered part of an acupuncturist’s visit and are not reimbursed separately.
Documentation must include the following:
- The diagnosis for the cause or origin of the symptom being treated.
- Evidence that the patient is responding favorably to the acupuncture treatment and that further improvement is expected with additional treatment.
- The acupuncture technique being requested.
- A comprehensive history and physical evaluation of the patient, completed prior to the start of acupuncture treatment that documents the cause or origin of the condition being treated. The provider must document this comprehensive history in the patient’s record.
- Plan of care for the acupuncture treatment.
- Other treatments the patient is receiving for the diagnosis, regardless of where or by whom they are being treated. Examples of other treatment may include opioids, physical therapy and medical cannabis.
- When applicable, provide documentation that favorable outcomes from acupuncture treatments have reduced the patient’s need for opioids or led to improved utilization of other treatment modalities.
Indications that are not covered
Acupuncture is not covered for any additional indication, including, but not limited to:
- Weight loss
- Drug or alcohol dependence
- Allergies or asthma
- Nausea due to conditions other than surgery, pregnancy or cancer care
- High blood pressure
- Cold or influenza
- Sexual dysfunction
Other types of Oriental medicine are not covered. MHCP does not cover the following: (This is not an all-inclusive list of non-covered Oriental medicine services.)
- Herbal supplements
Maintenance treatment where symptoms are not regressing or not showing improvement is not covered. Acupuncture treatment is not considered medically necessary if the recipient does not show improvement in symptoms.
Acupuncture Practice means a comprehensive system of health care using Oriental medical theory and its unique methods of diagnosis and treatment. Treatment techniques include the insertion of acupuncture needles through the skin and use of other biophysical methods of acupuncture point stimulation, including the use of heat, Oriental massage techniques, electrical stimulation, herbal supplemental therapies, dietary guidelines, breathing techniques, and exercise based on Oriental medical principles.
If available, codes are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.
Acupuncture, 1 or more needles; without electrical stimulation, initial 15 minutes of personal one-to-one contact with patient
Without electrical stimulation, each additional 15 minute of personal one-to-one contact with patient, with re-insertion of needle(s) (List separately in addition to code for primary procedure)
With electrical stimulation, initial 15 minutes of personal one-to-one contact with the patient
With electrical stimulation, each additional 15 minutes of personal one-to-one contact with the patient, with re-insertion of needles(s) (List separately in addition to code for primary procedure)
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This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.