Acupuncture Guidelines

Acupuncture is covered for most musculoskeletal conditions (excluding ankle sprain and carpal tunnel) and for a specified list of non‑musculoskeletal conditions (e.g., primary anxiety/depression/insomnia, fibromyalgia, cancer‑related symptoms, selected post‑stroke indications), and is explicitly not covered for maintenance, palliative or preventive care, non‑listed conditions, services without quantified deficits or appropriate assessments, treatments exceeding medically necessary frequency/duration, or when red flags are unaddressed. Coverage requires documented diagnosis and standardized, quantifiable outcome measures (pain scores or ADL deficits for musculoskeletal; condition‑specific assessments for non‑musculoskeletal), confirmation of medical co‑management when acupuncture is adjunctive (cancer, mental health, stroke), appropriate medical evaluation for minors, and date‑specific documentation (including for retrospective requests).

"Retrospective authorization requests are permissible only when submitted information adequately documents that acupuncture was performed on each date of service being requested."