Acupuncture Guidelines

Acupuncture is covered for musculoskeletal conditions (excluding ankle sprain and carpal tunnel) and a specified list of non‑musculoskeletal indications (e.g., cancer‑related symptoms, primary anxiety/depression/insomnia, fibromyalgia, post‑stroke conditions) and is excluded for maintenance/preventive/palliative care, treatments lacking quantified need or improvement, excluded diagnoses, or care exceeding medically necessary frequency/duration. Coverage requires a direct therapeutic relationship, documentation of addressed red flags, standardized quantified assessments (validated tools showing pain or ADL deficits and meeting MCID/MDC for continuation), confirmation of medical evaluation/diagnosis for non‑musculoskeletal conditions, and medical co‑management when acupuncture is used adjunctively for cancer, mental health, or stroke rehabilitation.

"Acupuncture Services for the treatment of a condition that is musculoskeletal in origin (excluding ankle sprain and/or carpal tunnel syndrome)."