BlueCross BlueShield of Tennessee Medical Policy Manual

Acupuncture

Does not apply to Medicare Advantage.

DESCRIPTION

Acupuncture is a traditional form of Chinese medical treatment that has been practiced for over 3000 years. Acupuncture involves 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 (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 defined by traditional Chinese medicine, the depth of insertion, and the stimulation of the inserted needle. The FDA has approved acupuncture needles.

Electroacupuncture (i.e., 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

IMPORTANT REMINDERS

Does not apply to Medicare Advantage.

ADDITIONAL INFORMATION

There is a lack of high-quality randomized controlled trials in peer-reviewed journals regarding acupuncture. There is a tendency to use sham acupuncture control groups with small sample sizes. Questions of efficacy remain. Also, issues of what is an adequate and optional acupuncture procedure remain.

SOURCES

American Cancer Society. (2010, May). Acupuncture. Retrieved November 11, 2011 from http://www.cancer.org/docroot/ETO/content/ETO_5_3X_Acupuncture.asp?sitearea=ETO&viewmode=print&.

BlueCross BlueShield Association. Medical Policy Reference Manual. (8:2009). Acupuncture. (7.01.01). Retrieved November 10, 2011 from BlueWeb. (90 articles and/or guidelines reviewed)

Complete Guide to Medicare Coverage Issues [Computer software]. (2013, April). Acupuncture - not covered (NCD 30.3, p. 2-30). OptumInsight, Inc.

Complete Guide to Medicare Coverage Issues [Computer software]. (2013, April). Acupuncture for fibromyalgia (NCD 30.3.1, p. 2-31). OptumInsight, Inc.

Complete Guide to Medicare Coverage Issues [Computer software]. (2013, April). Acupuncture for osteoarthritis (NCD 30.3.2, p. 2-31). OptumInsight, Inc.

Complete Guide to Medicare Coverage Issues [Computer software]. (2013, April). Outpatient hospital pain rehabilitation program (NCD 10.4, p. 2-2). OptumInsight, Inc.

ECRI Institute. Health Technology Information Service. Evidence Reports. (2006, August). Needle acupuncture for migraine. Retrieved November 11, 2011 from ECRI Institute. (98 articles and/or guidelines reviewed)

Kim, T. H., Kim, J. I., Shin, M. S., Lee, M. S., Choi, J. Y., Jung, S. Y., et al. (2009). Acupuncture for dry eye: A randomised controlled trial protocol. Trials, 10, (112). (Level 2 Evidence - Industry sponsored)

Kundu, A. & Berman. B. (2007). Acupuncture for pediatric pain and symptom management. Pediatric Clinics of North America, 54 (6), 885-889.

Lansdown, H., Howard, K., Brealey, S., & MacPherson, H. (2009). Acupuncture for pain and osteoarthritis of the knee: A pilot study for an open parallel-arm randomised controlled trial. BMC Musculoskeletal Disorders, 10, (130). (Level 1 Evidence - Independent study)

Lee, S., Liong, M. L., Yuen, K. H., Leong, W. S., Chee, C., Cheah, P. Y., et al. (2008). Acupuncture versus sham acupuncture for chronic prostatitis/chronic pelvic pain. The American Journal of Medicine, 121 (1), 79.e1-7. (Level 2 Evidence - Independent study)

Lu, W., Dean-Clower, E., Doherty-Gilman, A., & Rosenthal, D. S. (2008). The value of acupuncture in cancer care. Hematology/Oncology Clinics of North America, 22 (4), 631-648.

Manheimer, E., Lim, B., Lao, L., & Berman, B. (2006). Acupuncture for knee osteoarthritis - A randomized trial using a novel sham. Acupuncture in Medicine, 24 (Suppl.), S7-S14. (Level 1 Evidence - Independent study)

Mao, J. J., & Kapur, R. (2010). Acupuncture in primary care. Primary Care: Clinics in Office Practice, 37 (1), 105-117.

National Cancer Institute. (2013, June). Acupuncture. Retrieved June 25, 2013 from http://www.cancer.gov/cancertopics/pdq/cam/acupuncture/healthprofessional/page1/AllPages.

National Guideline Clearinghouse. (2006). Clinical practice guidelines for acupuncture. Retrieved November 11, 2011 from http://www.guidelines.gov.

National Guideline Clearinghouse. (2007, September). Diagnosis and management of headache. Retrieved November 11, 2011 from http://www.guidelines.gov.

National Guideline Clearinghouse. (2008, February). Osteoarthritis. The care and management of osteoarthritis in adults. Retrieved November 11, 2011 from http://www.guidelines.gov.

National Guideline Clearinghouse. (2009, January). Chiropractic management of tendinopathy: Summary of clinical practice recommendations for the Commission of the Council on Chiropractic Guidelines and Practice Parameters. Retrieved November 11, 2011 from http://www.guidelines.gov.

National Guideline Clearinghouse. (2009, March). Guideline for the evidence-informed primary care management of low back pain. Retrieved November 11, 2011 from http://www.guidelines.gov.

Smith, C. A., Crowther, C. A., Petrucco, O., Beilby, J., & Dent, H. (2011). Acupuncture to treat primary dysmenorrheal in women: A randomized controlled trial. Evidence-Based Complementary and Alternative Medicine, 2011 (612464), 1-11. (Level 3 Evidence - Independent study)

Takakura, N., & Yajima, H. (2009). Analgesic effect of acupuncture needle penetration: A double-blind crossover study. Open Medicine, 19 (2), e54-e61. (Level 2 Evidence - Independent study)

U. S. Department of Health & Human Services. National Institute of Health. National Center for Complementary and Alternative Medicine. (2011, August). Acupuncture: An introduction. Retrieved November 11, 2011 from http://nccam.nih.gov/health/acupuncture/introduction.htm.

U. S. Department of Health & Human Services. National Institute of Health. National Center for Complementary and Alternative Medicine. (2010, August). Acupuncture for pain. Retrieved November 11, 2011 from http://nccam.nih.gov/health/acupuncture/acupuncture-for-pain.htm.

U. S. Food and Drug Administration. (2006, November). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K061517. Retrieved March 11, 2010 from http://www.accessdata.fda.gov/cdrh_docs/pdf6/K061517.pdf.

Winifred S. Hayes, Inc. Medical Technology Directory. (2009, August; last update search August 2012). Acupuncture for the treatment of arthritis and fibromyalgia. Retrieved November June 26, 2013 from www.Hayesinc.com/subscribers. (83 articles and/or guidelines reviewed)

Winifred S. Hayes, Inc. Medical Technology Directory. (2009, May; last update search February 2013). Acupuncture for treatment of headache. Retrieved June 26, 2013 from www.Hayesinc.com/subscribers. (66 articles and/or guidelines reviewed)

Winifred S. Hayes, Inc. Medical Technology Directory. (2009, May; last update search May 2013). Acupuncture for treatment of postoperative pain. Retrieved June 26, 2013 from www.Hayesinc.com/subscribers. (53 articles and/or guidelines reviewed)

Winifred S. Hayes, Inc. Medical Technology Directory. (2010, December; last update search January 2013). Acupuncture for treatment of neck and shoulder pain. Retrieved June 26, 2013 from www.Hayesinc.com/subscribers. (79 articles and/or guidelines reviewed)

Winifred S. Hayes, Inc. Medical Technology Directory. (2010, June; last update search June 2013). Acupuncture and acupressure for the treatment of nausea and vomiting . Retrieved June 26, 2013 from www.Hayesinc.com/subscribers. (103 articles and/or guidelines reviewed)

Winifred S. Hayes, Inc. Medical Technology Directory. (2011, July; last update search July 2012). Acupuncture for assisted reproduction. Retrieved June 26, 2013 from www.Hayesinc.com/subscribers. (82 articles and/or guidelines reviewed)

Winifred S. Hayes, Inc. Medical Technology Directory. (2011, October; last update search October 2012). Acupuncture for treatment of low back pain. Retrieved June 26, 2013 from www.Hayesinc.com/subscribers.  (66 articles and/or guidelines reviewed)

Zhao, L., Liang, F. R., Li, Y. Zhang, F. W., Zheng, H., & Wu, X. (2009). Improved quality monitoring of multi-center acupuncture clinical trials in China. Trials, 10 (123).

ORIGINAL EFFECTIVE DATE:  11/24/1978

MOST RECENT REVIEW DATE:  8/8/2013

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.

This document has been classified as public information.