Acupuncture - (CPG024)

Cigna covers acupuncture (CPT 97810, 97811, 97813, 97814) only when the member’s benefit plan permits and the claim is for listed ICD‑10‑CM diagnoses—notably tension‑type and migraine headaches, musculoskeletal joint/soft‑tissue or joint pain with functional deficit, and nausea related to pregnancy, surgery, or chemotherapy (when co‑managed); acupuncture for other diagnoses (including infertility), maintenance without expected improvement, general conditioning, and acupuncture‑point injection (CPT 20550–20553) is excluded or considered experimental/not medically necessary. Coverage requires meeting ALL medical‑necessity and treatment‑planning/outcome criteria (documented severity, objective functional measures, time‑framed goals, detailed initial evaluation and ongoing outcome documentation), an initial 2–4 week trial with documented improvement to continue care, and use of the stated CPT/ICD‑10 codes.

"Acupuncture may be provided as treatment when coverage for acupuncture services is available in the applicable benefit plan document and ALL medical necessity factors and ALL treatment planning/out..."