Acupuncture Guidelines

Acupuncture is medically necessary for musculoskeletal conditions (excluding ankle sprain and carpal tunnel) and for a defined list of non‑musculoskeletal indications (e.g., adjunct cancer symptoms — pain, fatigue, chemo‑nausea, aromatase‑inhibitor arthralgia — primary anxiety/depression/insomnia as adjunct, post‑stroke impairments including dysphagia, fibromyalgia, IBS, asthma, allergic rhinitis, dry eye, chronic constipation, chronic prostatitis, menopausal hot flashes), while maintenance, preventive, palliative care (except some adjunct cancer care), treatments that replace/delay necessary medical care, and non‑listed systemic/visceral/CNS conditions are excluded. Coverage requires substantive clinical documentation showing musculoskeletal origin when applicable or direct focus on an included condition, quantified pain/ADL deficits or standardized assessments, documented objective improvement for continuations (MCID/MDC), and evidence of appropriate medical co‑management/adjunctive use for cancer, mental health, and stroke (with SLP assessment required for post‑stroke dysphagia).