Acupuncture Guidelines

Acupuncture is covered as medically necessary for musculoskeletal conditions to restore function/quality of life (excluding ankle sprain and carpal tunnel) and for a specific list of non‑musculoskeletal diagnoses (e.g., allergic rhinitis, primary depression/anxiety/insomnia, fibromyalgia, IBS, asthma, dry eye, menopausal hot flashes, aromatase‑inhibitor arthralgia, chronic constipation/prostatitis, adjunct cancer care, and specified post‑stroke rehabilitation indications); excluded are maintenance, preventive or palliative care generally, non‑listed systemic/visceral/CNS/infectious conditions, treatment unrelated to the complaint region, and services that replace or delay necessary care. Key requirements: baseline and follow‑up standardized quantified assessments with documentation of MCID/MDC or a defined exacerbation/response for continuation, documentation that acupuncture is primarily focused on an included diagnosis, evidence of appropriate co‑management for adjunct cancer/mental‑health/stroke care, and withholding/referral for specified red flags.