BlueCross BlueShield of Tennessee Medical Policy Manual

Complementary and Alternative Medicine


Complementary and alternative medicine (CAM), as defined by the National Center for Complementary and Integrative Health (NCCIH), is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Therapies and diagnostics are termed “complementary” when used in addition to conventional medicine while therapies and diagnostics used in place of conventional medicine are considered “alternative”. Complementary health approaches typically include natural products, mind and body practices, and the practices of traditional healers (e.g., Chinese medicine, homeopathy and naturopathy).

Integrative Medicine (IM) combines state of the art conventional medicine with alternative modalities to stimulate the body's natural healing potential. IM is based upon a model of health and wellness, as opposed to a model of disease. It seeks to care for the whole person by taking into account the many interrelated physical and nonphysical factors that affect health, wellness, and disease.




While scientific evidence exists for some CAM therapies and diagnostics, for most there are key questions that are yet to be answered through well-designed scientific studies. Systematic reviews of traditional Chinese medicine were inconclusive due specifically to poor methodology and heterogeneity of the studies.

Complementary and alternative medicine including, but not limited to, those listed above, do not meet the following Technology Evaluation Center (TEC) criteria:


Ali, A., Njike, V., Northrup, V., Sabina, A., Williams, A., Liberti, L., Perlman, A., et al. (2009). Intravenous micronutrient therapy (Myers’ cocktail) for fibromyalgia: a placebo-controlled pilot study. Journal of Alternative and Complementary Medicine, 15 (3), 247-257. (Level 2 evidence)

American Academy of Allergy, Asthma & Immunology. (2014). Food allergy: a practice parameter update - 2014. Retrieved November 10, 2017 from

American Cancer Society. (2017). Complementary and alternative methods and cancer. Retrieved November 13, 2017 from

American College of Medical Genetics and Genomics (ACMG). (2013, February). ACMG practice guideline: lack of evidence for MTHR polymorphism testing. Retrieved November 9, 2017 from

American College of Obstetricians and Gynecologists. (2007, reaffirmed 2019). Vaginal “rejuvenation” and cosmetic vaginal procedures. ACOG Committee Opinion Number 378. Retrieved September 30, 2019 from

American College of Obstetrics and Gynecologists. (2012, reaffirmed 2018). Compounded Bioidentical Menopausal Hormone Therapy. Committee Opinion No. 532: Retrieved September 30, 2019 from

American Society of Plastic Surgeons. (2012). The vampire facelift: not really a face lift and no vampires involved. Retrieved November 6, 2017 from

Atalay, N., Sahin, F., Atalay, A., & Akkaya, N. (2013). Comparison of efficacy of neural therapy and physical therapy in chronic low back pain. African Journal of Traditional, Complementary and Alternative Medicines, 10 (3), 431-435. (Level 3 evidence)

BlueCross BlueShield Association. Evidence Positioning System. (12:2020). Neural therapy (2.01.85). Retrieved December 30, 2020 from (13 articles and/or guidelines reviewed)

BlueCross BlueShield Association. Evidence Positioning System. (11:2020). Antigen leukocyte antibody test (2.01.93). Retrieved December 30, 2020 from (7 articles and/or guidelines reviewed)

BlueCross BlueShield Association. Evidence Positioning System. (1:2020). Nutrient/Nutritional Panel Testing (2.04.136). Retrieved February 4, 2020 from (12 articles and/or guidelines reviewed)

BlueCross BlueShield Association. Evidence Positioning System. (8:2020). Miscellaneous genetic and molecular diagnostic tests (2.04.121). Retrieved December 30, 2020 from (40 articles and/or guidelines reviewed)

Demir, E., Ozkan, H., Seckin, K.D., Sahtiyanci, B., Demir, B., Tabak, O., et al. (2019). Plasma zonulin levels as a non-invasive biomarker of intestinal permeability in women with gestational diabetes mellitus. Biomolecules, 9 (24), 1-8. (Level 4 evidence)

Hinz, M., Stein, A., & Uncini, T. (2011). Validity of urinary monamine assay sales under the “spot baseline urinary neurotransmitter testing marketing model”. International Journal of Nephrology and Renovascular Disease, 4, 101-113. (Level 2 evidence)

Hinz, M., Stein, A., Trachte, G., & Uncini, T. (2010). Neurotransmitter testing of the urine: a comprehensive analysis. Open Access Journal of Urology, 2, 177-183. (Level 2 evidence)

Jiménez, M., & Molina Mora, J. (2017). Effect of heart rate variability biofeedback on sport performance, a systematic review. Applied Psychophysiology and Biofeedback, 42 (3), 235-245. Abstract retrieved February 4, 2020 from PubMed database.

Khan, Z. & Ali, S.A. (2018). Oxidative stress-related biomarkers in Parkinson’s disease: a systematic review and meta-analysis. Iranian Journal of Neurology, 17 (3), 137-144. (Level 1 evidence)

Nair, N. & Gongora, E. (2017). Oxidative stress and cardiovascular aging: interaction between NRF-2 and ADMA. Current Cardiology Reviews, 13, 183-188. (Level 2 evidence)

National Institute of Allergy and Infectious Diseases. (2010) Guidelines for the diagnosis and management of food allergy in the United States. Retrieved July 16, 2012 from

National Institutes of Health. National Center for Complementary and Integrative Health. (2017). Health topics A – Z. Retrieved November 10, 2017 from

Seely, D., Szczurko, O., Cooley, K., Fritz, H., Aberdour, S., Herrington, C., Herman, P., et al. (2013). Naturopathic medicine for the prevention of cardiovascular disease: a randomized clinical trial. Canadian Medical Association Journal, 185 (9), E409-E416. (Level 2 evidence)

Tennessee Code: Title 63 Professions of the Healing Arts: Chapter 6 Medicine and Surgery: Part 2 General Provisions: 63-6-205. Practice of naturopathy. Retrieved December 30, 2020 from

U. S. Food and Drug Administration. (2011, April). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K101867. Retrieved July 3, 2012 from

United States Department of Labor. Occupational Safety and Health Administration. (2017). Multiple chemical sensitivities. Retrieved November 16, 2017 from

Villafaina, S., Collado-Mateo, D., Fuentes, J., Merellano-Navarro, E., & Gusi, N. (2017). Physical exercise improves heart rate variability in patients with type 2 diabetes: a systematic review. Current Diabetes Reports, 17 (11), 110. Abstract retrieved November 7, 2017 from PubMed database.

Wegh, C.A.M., de Roos, N.M., Hovenier, R., Meijerink, J., Besseling-van der Vaart, I., van Hemert, S., & Witteman, B.J.M. (2019). Intestinal permeability measured by urinary sucrose excretion correlates with serum zonulin and faecal calprotectin concentrations in UC patients in remission. Journal of Nutrition and Metabolism, volume 2019, article ID 2472754. (Level 2 evidence)

Yip, K., & Alonzi, R. (2013). Carbogen gas and radiotherapy outcomes in prostate cancer. Therapeutic Advances in Urology, 5 (1), 25-34. (Level 4 evidence)




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