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 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 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.

SOURCES

Agency for Healthcare Research and Quality. (2010, October). Complementary and alternative therapies for back pain II. Retrieved January 26, 2016 from http://www.ahrq.gov/.

American Academy of Orthopaedic Surgeons. (2013, May). American Academy of Orthopaedic Surgeons clinical practice guideline on the treatment of osteoarthritis of the knee, 2nd edition. Retrieved January 25, 2016 from the National Guideline Clearinghouse (NGC: 009911).

American Academy of Otolaryngology – Head and Neck Surgery Foundation. (October, 2014). Clinical practice guidelines: tinnitus. Retrieved January 26, 2016 from the National Guideline Clearinghouse (NGC: 10567).

American College of Occupational and Environmental Medicine. (2011). Cervical and thoracic spine disorders. Retrieved January 26, 2016 from the National Guideline Clearinghouse (NGC: 8890).

Centers for Medicare & Medicaid Services. CMS.gov. NCD for Acupuncture (30.3). Retrieved January 25, 2016 from https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=11&ncdver=1&DocID=30.3&kq=true&bc=gAAAAAgAAAAAAA%3d%3d&.

Centers for Medicare & Medicaid Services. CMS.gov. NCD for Acupuncture for Osteoarthritis (30.3.2). Retrieved January 25, 2016 from https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=284&ncdver=1&DocID=30.3.2&from2=search.asp&bc=gAAAAAgAAAAAAA%3d%3d&.

Centers for Medicare & Medicaid Services. CMS.gov. NCD for Acupuncture for Fibromyalgia (30.3.1). Retrieved January 25, 2016 from https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=283&ncdver=1&DocID=30.3.1&from2=search.asp&bc=gAAAAAgAAAAAAA%3d%3d&.

Karlson, G. & Bennicke, P. (2013). Acupuncture in asthmatic children: a prospective, randomized, controlled clinical trial of efficacy. Alternative therapies in health and medicine, 19 (4), 13-19. Abstract retrieved January 26, 2016 from PubMed database.

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)

National Cancer Institute. (2015, November). Acupuncture. Retrieved January 26, 2016 from http://www.cancer.gov/about-cancer/treatment/cam/hp/acupuncture-pdq

North American Spine Society (NASS). (2010). Diagnosis and treatment of cervical radiculopathy from degenerative disorders. Retrieved January 26, 2016 from the National Guideline Clearinghouse (NGC: 8008).

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)

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. (2010, December; last update search February 2014). Acupuncture for treatment of neck and shoulder pain. Retrieved November 11, 2011 from www.Hayesinc.com/subscribers. (76 articles and/or guidelines reviewed)

Winifred S. Hayes, Inc. Medical Technology Directory. (2011, July; last update search June 2015). Acupuncture for assisted reproduction. Retrieved January 25, 2016 from www.Hayesinc.com/subscribers. (82 articles and/or guidelines reviewed)

ORIGINAL  EFFECTIVE DATE:  11/24/1978

MOST RECENT REVIEW DATE:  3/10/2016

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.