Acupuncture Guidelines

EviCore covers acupuncture only when medically necessary for musculoskeletal conditions and a specified list of non‑musculoskeletal indications (including defined adjunct indications for cancer care, primary anxiety/depression/insomnia, and post‑stroke rehabilitation) and excludes maintenance, preventive, palliative care, non‑listed non‑musculoskeletal disorders, treatments without a direct therapeutic relationship, or services that replace/delay necessary care. Key requirements include documentation of musculoskeletal origin or condition‑specific focus, quantified baseline pain/ADL deficits and standardized assessment scores, demonstration of improvement (MCID/MDC or significant quantified QoL/ADL gains) for continuation, appropriate oncologist/therapist co‑management for adjunct indications, and resolution of red flags or need for medical co‑management before treatment.

"Musculoskeletal conditions: Acupuncture Services reasonable and necessary for evaluation, diagnosis, and treatment of a condition to restore lost function or quality of life resulting from an injur..."