BlueCross BlueShield of Tennessee Medical Policy Manual

Acupuncture

Does not apply to Medicare Advantage and Commercial claims.

Applies only to BlueCare and CoverKids.

DESCRIPTION

Acupuncture is a traditional form of Chinese medical treatment that has been practiced for over 3,000 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 or meridian as defined by traditional Chinese medicine, the depth of insertion, and the manual stimulation of the inserted needle.

Electroacupuncture (i.e. transcutaneous electrical nerve stimulation acupuncture) is the practice of piercing specific body sites with needles that are stimulated by an extremely low voltage of electricity.

POLICY

MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

Does not apply to Medicare Advantage and Commercial claims.

Applies only to BlueCare and CoverKids.

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/.

Agency for Healthcare Research and Quality. (2018, June). Noninvasive nonpharmacological treatment for chronic pain: a systematic review. Retrieved August 2, 2018 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 August 2, 2018 from www.aaos.com.

American College of Physicians (2017, April) Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline. Annals of Internal Medicine, 166, 514-530.

American Society of Clinical Oncology. (2017, April). Antiemetics: clinical practice guideline update. Retrieved April 17, 2018 from www.ascopubs.org.

Bearn, J., Swami, A., Stewart, D., Atnas, C., Giotto, L., Gossop, M., et al (2009, April). Auricular acupuncture as an adjunct to opiate detoxification treatment: effects on withdrawal symptoms. Journal of Substance Abuse Treatment, 36 (3), 345-349. (Level 2 evidence)

BlueCross BlueShield Association. Medical Policy Reference Manual (2017, November) Acupuncture for pain management, nausea and vomiting, and opioid dependence. Retrieved April 4, 2018 from BlueWeb. (29 articles and/or guidelines reviewed)

Centers for Medicare & Medicaid Services. CMS.gov. (2004, April) National Coverage Determination (NCD) for Acupuncture for Osteoarthritis (30.3.2). Retrieved January 25, 2016 from https://www.cms.gov.

Centers for Medicare & Medicaid Services. CMS.gov. (2004, April) National Coverage Determination (NCD) for Acupuncture for Fibromyalgia (30.3.1). Retrieved January 25, 2016 from https://www.cms.gov.

Centers for Medicare & Medicaid Services. CMS.gov. (No Date) National Coverage Determination (NCD) for Acupuncture (30.3). Retrieved January 25, 2016 from https://www.cms.gov.

Falci, L., Shi, X., and Greenlee, H. (2016, May). Multiple chronic conditions and use of complementary and alternative medicine among US adults: results from the 2012 national health interview survey. Retrieved April 4, 2018 from www.cdc.gov.

Institute for Clinical and Economic Review (2017, October). Cognitive and mind-body therapies for chronic low back and neck pain: effectiveness and value. Retrieved April 17, 2018 from http://www.icer-review.org.

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)

McKee, D., Kligler, B., Blank, A., Fletcher, J., Jeffres, A., Casalaina, W., et al. (2012) The ADDOPT study (Acupuncture to Decrease Disparities in Pain Treatment): feasibility of offering acupuncture in the community health center setting. The Journal of Alternative and Complimentary Medicine, 18 (9), 839-843. (Level 3 evidence)

National Institute for Health and Care Excellence (2012, September). Clinical guideline: Headaches in over 12s: diagnosis and management. Retrieved April 17, 2018 from www.nice.org.uk.

National Institute for Health and Care Excellence (2014, February). Clinical guideline: Osteoarthritis: care and management. Retrieved April 17, 2018 from www.nice.org.uk.

National Institute for Health and Care Excellence (2016, November). Clinical guideline: Low back pain and sciatica in over 16s: assessment and management. Retrieved April 17, 2018 from www.nice.org.uk.

National Institute of Health. (1997, November). NIH consensus statement on acupuncture. Retrieved August 2, 2018 from https://consensus.nih.gov.

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)

Shen, F., Samartzis, D., and Andersson, G. (2006, August) Nonsurgical management of acute and chronic low back pain. Journal of American Academy of Orthopaedic Surgeons, 14 (8), 477-87. Abstract retrieved April 17, 2018 from PubMed database.

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

Veterans Health Administration, Department of Defense (2014, October) VA/DoD clinical practice guideline for the management of chronic multisymptom illness. Retrieved August 2, 2018 from https://www.healthquality.va.gov.

Windmill, J., Fisher, E., Eccleston, C., Derry, S., Stannard, C., Knaggs, R., et al. (2013, September) Interventions for the reduction of prescribed opioid use in chronic non-cancer pain. Cochrane Database Systematic Review, 1 (9). CD010323. Abstract retrieved August 2, 2018 from PubMed database.

Yan, B., Li, K., Xu, J., Wang, W., Li, K., Liu, H., et al. (2005, August) Acupoint-specific fMRI patterns in human brain. Neuroscience Letters, 5 (383), 236-40. Abstract retrieved August 2, 2018 from PubMed database.

ORIGINAL  EFFECTIVE DATE:  11/24/1978

MOST RECENT REVIEW DATE:  1/1/2019

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.

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