1

Clinical Policy Title: Acupuncture

Clinical Policy Number: CCP.1155

Effective Date: April 1, 2015

Initial Review Date: January 21, 2015

Most Recent Review Date: April 2, 2019

Next Review Date: April 2020

Related policies:

None.

ABOUT THIS POLICY: AmeriHealth Caritas has developed clinical policies to assist with making coverage determinations. AmeriHealth Caritas’s clinical policies are based on guidelines from established industry sources, such as the Centers for Medicare & Medicaid Services (CMS), state regulatory agencies, the American Medical Association (AMA), medical specialty professional societies, and peer-reviewed professional literature. These clinical policies along with other sources, such as plan benefits and state and federal laws and regulatory requirements, including any state- or plan-specific definition of “medically necessary,” and the specific facts of the particular situation are considered by AmeriHealth Caritas when making coverage determinations. In the event of conflict between this clinical policy and plan benefits and/or state or federal laws and/or regulatory requirements, the plan benefits and/or state and federal laws and/or regulatory requirements shall control. AmeriHealth Caritas’s clinical policies are for informational purposes only and not intended as medical advice or to direct treatment. Physicians and other health care providers are solely responsible for the treatment decisions for their patients. AmeriHealth Caritas’s clinical policies are reflective of evidence-based medicine at the time of review. As medical science evolves, AmeriHealth Caritas will update its clinical policies as necessary. AmeriHealth Caritas’s clinical policies are not guarantees of payment.

Coverage policy AmeriHealth Caritas considers the use of acupuncture to be clinically proven and, therefore, medically

necessary when performed by a qualified practitioner who is appropriately trained and licensed in

acupuncture and when all the following criteria are met:

For patients age 18 years or older:

Patient needs treatment for one of the following medical conditions:

- Chemotherapy-induced or postoperative nausea and vomiting (Cheong, 2013;

Garcia, 2013; Lau, 2016; Lee, 2015).

- Acute, subacute, or chronic (lasting more than three months) non-specific lower

back pain (Qaseem, 2017).

- Chronic migraine (Linde, 2009, 2016b).

- Chronic pain caused by osteoarthritis of the knee (Hochberg, 2012; Manyanga,

2014; Vickers, 2017; Zhang, 2017).

- Temporomandibular disorders (Fernandes, 2017; Gil-Martínez, 2018; Wu, 2017).

As adjunctive treatment when either of the following conditions applies:

- Other standard treatment options inadequately control symptoms.

Policy contains:

Chronic migraine.

Knee osteoarthritis.

Low back pain.

Nausea and vomiting.

Temporomandibular disorders.

2

- Patient refuses treatment or experiences adverse effects from such treatment.

Limitations:

All other uses of acupuncture are not medically necessary. Please note:

Maintenance treatment, when the member’s symptoms are neither regressing nor

improving, is not medically necessary.

For chronic tension-type headaches in youth over 12 years old, up to 10 sessions of

acupuncture over 5—8 weeks may be provided.

Children should not be treated with acupuncture for nausea and vomiting while under

anesthesia.

Treatments beyond five visits without meaningful improvement in symptoms require review

by a medical director.

For Medicare members only:

AmeriHealth Caritas considers the use of acupuncture to be investigational and, therefore, not medically

necessary.

Alternative covered services:

Standard medical management of chronic pain syndromes or nausea and vomiting due to

chemotherapy or anesthesia.

Background

Acupuncture is one of the practices of traditional Chinese medicine, which considers energy known as

“qi” to flow throughout the body along patterns known as meridians (National Center for

Complementary and Integrative Health, 2014). Disturbances in the flow of qi are believed to result in

disease. Acupuncture is based on the theory that stimulating specific points on the body corrects

imbalances in the flow of qi, thereby improving health. The approach has four components:

Acupuncture needle(s).

Target location mapped by traditional Chinese medicine.

Depth of needle insertion.

Stimulation of the inserted needle.

Traditional acupuncture uses thin needles, but it may also apply manual pressure, electrical stimulation,

magnets, low-power lasers, heat, and ultrasound. The U.S. Food and Drug Administration regulates

acupuncture needles as Class II medical devices with special controls. Acupuncture needles must be

labeled for single use only, biocompatible and sterile, and administered by qualified practitioners only

(21CFR880.5580).

3

The professional credentials of an acupuncture practitioner can range from none to licensed medical

doctor. Licensure laws and scope-of-practice guidelines regulating acupuncture practitioners vary by

state. Currently, 22 states require the passage of National Certification Commission for Acupuncture and

Oriental Medicine examinations, and 21 states and the District of Columbia specify National Certification

Commission for Acupuncture and Oriental Medicine certification as a prerequisite for licensure (2018).

Board certification in medical acupuncture is granted by the American Board of Medical Acupuncture

(2019). Certification entails:

Meeting minimum general requirements.

Meeting education and training requirements.

Meeting experience requirements.

Successfully passing the American Board of Medical Acupuncture examination.

Searches

AmeriHealth Caritas searched PubMed and the databases of:

UK National Health Services Centre for Reviews and Dissemination.

Agency for Healthcare Research and Quality.

The Centers for Medicare & Medicaid Services.

We conducted searches on November 27, 2018. Search terms were: “acupuncture” (MeSH) and

“acupuncture therapy” (MeSH), as well as free text “acupuncture” for articles published in English.

We included:

Systematic reviews, which pool results from multiple studies to achieve larger sample sizes

and greater precision of effect estimation than in smaller primary studies. Systematic

reviews use predetermined transparent methods to minimize bias, effectively treating the

review as a scientific endeavor, and are thus rated highest in evidence-grading hierarchies.

Guidelines based on systematic reviews.

Economic analyses, such as cost-effectiveness, and benefit or utility studies (but not simple

cost studies), reporting both costs and outcomes — sometimes referred to as efficiency

studies — which also rank near the top of evidence hierarchies.

Findings

Given the substantial volume of literature on this topic, AmeriHealth Caritas considered only the most

comprehensive systematic reviews of acupuncture published in the last five years. More than 100

systematic reviews and meta-analyses were identified, the majority of which found evidence for various

clinical uses of acupuncture to be of low quality. Conflicting results were also evident.

4

An evidence map of acupuncture (not a formal systematic review) produced for the Veterans Health

Administration, which identified 183 systematic reviews published since 2005, found inconsistency in

the quality and findings of systematic reviews (Hempel, 2014). Inconsistency in results appeared to be

related to the selection of the comparator to which the treatment effects of acupuncture were

compared. Controls included no treatment, waiting list assignment, acupuncture as add-on treatment to

a treatment plan received by both treatment groups, placebo control (such as sham acupuncture), and

active controls, such as exercise and usual care. Typically, trials included a placebo arm and a no-

treatment arm to explore variations in the impact of the different types of placebo. There is currently no

universal standard for what constitutes an appropriate method or procedure for a sham acupuncture

control, and this may contribute to the discrepancy between observed clinical effectiveness of

acupuncture and the lack of rigorous research supporting these observations for many indications.

Therefore, this policy will focus on those indications for which there is high-quality and consistent

evidence demonstrating improvement in health outcomes with acupuncture. Nine systematic reviews

are listed in the summary table. Eight evidence-based guidelines and two economic analyses pertaining

to the topics of these syntheses were identified.

There is sufficient evidence to support the use of acupuncture as adjunctive treatment for certain types

of chronic pain and nausea and vomiting. Included were individual syntheses for the following

indications:

Postoperative- or chemotherapy-induced nausea and vomiting.

Chronic non-specific low back pain.

Chronic migraine.

Osteoarthritis of the knee.

The benefits of acupuncture are limited mostly to immediate and short-term post-treatment periods in

patients ages 18 and older using sham or no-acupuncture controls. Evidence of its effectiveness over

other conventional treatment modalities is conflicting or of low quality. Evidence-based guidelines listed

in the references recommend acupuncture as an adjunct to standard treatment for the specific

indications listed, when other treatment options inadequately control symptoms, or when patients

refuse treatment or experience adverse effects from such treatment. One guideline did not recommend

acupuncture for the management of osteoarthritis of the knee (Jevsevar, 2013).

While acupuncture is generally a safe procedure, reporting of harms was poor across studies, so a

comparison of the rate of adverse events between acupuncture and other treatments cannot be made.

When performed by an appropriately trained practitioner using clean technique and single-use needles,

reported adverse events were generally localized, minor, transient, and infrequent. When acupuncture

is not delivered properly, it may result in serious adverse effects. These include infections, punctured

organs, collapsed lungs, injury to the central nervous system, and even death (Ernst, 2011; National

Center for Complementary and Integrative Health, 2016).

5

There is insufficient evidence to draw conclusions regarding the optimal frequency of

administration, duration of each session, number, depth of needle penetration, or needle

location.

There is insufficient evidence to support the cost-effectiveness of acupuncture for any

indication. The few cost-effectiveness analyses that have been conducted in the United

States found either a lack of effectiveness or sufficient rigor needed to further inform

practice (Kim, 2012; Pinto, 2012).

Policy updates:

In the 2016 update, we identified 26 new systematic reviews and meta-analyses and one new clinical

practice guideline published in the last year. Seven systematic reviews and meta-analyses reported

significant short-term or intermediate-term positive effects of acupuncture treatment for several

conditions, but significant study design flaws and small numbers of studies limited the validity of the

evidence included in these analyses (Chan, 2015; Dong, 2015; Feng, 2015; Gutke, 2015; Law, 2015; Yuan,

2015; Zhou, 2015). One clinical practice guideline stated acupuncture could be a non-pharmacologic

option for allergic rhinitis based on moderate evidence from two large randomized controlled trials

reporting improvement in symptoms and quality of life with acupuncture, but stopped short of issuing a

firm recommendation for its use (Seidman, 2015). The new information would not alter the conclusions

of the original policy. Therefore, no changes to the policy were warranted.

In the 2017 update, we identified 15 new systematic reviews and meta-analyses and one new evidence-

based guideline for this policy. New evidence confirmed previous policy findings of acupuncture’s safety

and efficacy in tension-type headache (Linde, 2016a), migraine (Linde, 2016b), and palliation of

chemotherapy-induced nausea and vomiting (Lau, 2016), as well as insufficient demonstration of safety

and efficacy in chronic pain syndromes (Qin, 2016), and post-operative pain (Wu, 2016).

The results of several systematic reviews and meta-analyses suggested acupuncture had a limited

treatment effect on a number of new clinical indications, but the evidence of safety and efficacy was

inconclusive due to poor methodological quality, insufficient quantity, or conflicting findings (Cui, 2016;

del Pino-Sedeno, 2016; He, 2016; Kim, 2016; Lim, 2016; Mangese, 2016; Smith, 2016; Su, 2016; Van den

Heuvel, 2016; Yang, 2016). A guideline by the American College of Physicians on treatments (including

acupuncture) for major depressive disorder in adults issued strong evidence-based recommendations

for cognitive behavioral therapy and antidepressants, but made no specific recommendation for

acupuncture (Qaseem, 2016). The new information did not change the original findings. Therefore, no

policy changes were warranted.

In the 2018 update, we added five guidelines and five peer-reviewed articles to the reference list. Of

these, we added three publications to the table of evidence. A guideline developed by the American

College of Physicians (Qaseem, 2017) on noninvasive treatments for lower back pain issued strong

recommendations for acupuncture as a nonpharmacologic treatment for acute or subacute lower back

pain based on low-quality evidence, and for chronic lower back pain based on moderate quality

6

evidence. With this recommendation, we have added acupuncture for acute or subacute lower back

pain to the policy. In other published guidelines, reviews found insufficient evidence to support or refute

the use of acupuncture for restless leg syndrome (Winkelman, 2016) or to support the use of

acupuncture for post-traumatic stress disorder (Management of Posttraumatic Stress Disorder Work

Group, 2017). Acupuncture is not recommended for eating disorders (National Institute for Health and

Care Excellence, 2017). Two meta-analyses support the use of acupuncture in Parkinson’s disease (Lee,

2017; Liu, 2017).

In 2019, the policy ID changed from 03.02.03 to CCP.1155. We added five professional society guidelines

and nine peer-reviewed publications to the policy.

Regarding adult care, one systematic review (Fernandes, 2017), one meta-analysis (Wu, 2017), and one

review article (Gil-Martínez, 2018) support acupuncture as a treatment for the chronic pain associated

with temporomandibular disorders. Although much of the data examined feature small sample sizes and

short-term follow-up periods (e.g., 12 weeks), these studies demonstrate that conventional acupuncture

results in statistically significant pain reduction, especially in those with myofascial pain. Therefore,

“temporomandibular disorders” has been added to the list of indications covered by this policy.

Regarding pediatric care, there have been fewer studies of acupuncture in children compared to the

body of research among adults. Acupuncture appears to result in few adverse effects in children when

performed by a qualified practitioner. In some conditions, it may be used to decrease the use of

prescription medication.

Brittner’s (2016) systematic review found that the strongest body of evidence for the efficacy and safety

of acupuncture in pediatric populations at that time was for headache, migraine, and postoperative

pain. Brittner’s view was that acupuncture may be considered for nausea and vomiting, but not while

children are under anesthesia, when it is less effective. Lee’s (2015) Cochrane review on the topic of

wrist acupuncture (using the point PC6) for postoperative nausea and vomiting found a moderate effect

size for both children and adults, to the extent that further sham studies to confirm this benefit were

deemed unnecessary. For chronic tension-type headaches in youth over 12 years old, up to 10 sessions

of acupuncture over 5—8 weeks may be considered (National Institute of Health and Care Excellence,

2015). The American Academy of Pediatrics published a policy article (McClafferty, 2017) on the topic of

integrative medicine that included a section on acupuncture summarizing the above findings.

A systematic review of 24 systematic reviews found promising evidence for the efficacy of acupuncture

for several other uses in children, including pain conditions, nocturnal enuresis, tic disorders, amblyopia,

and cerebral palsy, however, only six of the included studies were deemed to be of high quality, sample

sizes were small, most included studies lacked data on safety and adverse events, and a quantitative

analysis could not be performed due to heterogeneity (Yang, 2015).

Adams (2011) identified 279 adverse events in 1422 pediatric patients, some of whom experienced

more than one event. These included 25 serious adverse events consisting of thumb deformity (12),

7

infections (5), one incident each of cardiac rupture, pneumothorax, nerve impairment, subarachnoid

hemorrhage, intestinal obstruction, hemoptysis, reversible coma, and overnight hospitalization, and one

moderate effect (infection). Adams calculated a mild adverse effect incidence per patient of 168 in 1422

patients (11.8 percent, 95 percent confidence interval 10.1-13.5). Yang (2015) noted that some

developmental issues, such as open fontanel in infants, leaves them vulnerable to use of needles in the

affected region.

With the above evidence, we are adding acupuncture for use in treatment of pediatric headache,

migraine, postoperative nausea and vomiting, and postoperative pain to the coverage policy.

References

Professional society guidelines/other:

American Board of Medical Acupuncture, Inc. Requirements for certification in medical acupuncture.

2009. http://www.dabma.org/requirements.asp. Accessed February 7, 2019.

American Society of Anesthesiologists Task Force on Chronic Pain Management; American Society of

Regional Anesthesia and Pain Medicine. Practice guidelines for chronic pain management: an updated

report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the

American Society of Regional Anesthesia and Pain Medicine. Anesthesiology. 2010; 112(4): 810-833. Doi:

10.1097/ALN.0b013e3181c43103. http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1932775.

Accessed February 7, 2019.

Deng GE, Rausch SM, Jones LW, et al. Complementary therapies and integrative medicine in lung cancer:

Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based

clinical practice guidelines. Chest. 2013;143(5 Suppl):e420S-436S. Doi: 10.1378/chest.12-2364.

Gan TJ, Diemunsch P, Habib AS, et al. Consensus guidelines for the management of postoperative

nausea and vomiting. Anesth Analg. 2014;118(1):85-113. Doi: 10.1213/ANE.0000000000000002.

Knee disorders. In: Hegmann K, ed. Occupational medicine practice guidelines. Evaluation and

management of common health problems and functional recovery in workers. 3rd ed. Elk Grove Village

(IL): American College of Occupational and Environmental Medicine (ACOEM); 2011:1-503.

Hochberg MC, Altman RD, April KT, et al. American College of Rheumatology 2012 recommendations for

the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee.

Arthritis Care Res. 2012; 64(4): 465-474. Doi: 10.1002/acr.21596.

Jevsevar DS, Brown GA, Jones DL, et al. The American Academy of Orthopaedic Surgeons evidence-

based guideline on: treatment of osteoarthritis of the knee 2nd edition. J Bone Joint Surg Am. 2013;

95(20): 1885-1886.

8

https://www.aaos.org/cc_files/aaosorg/research/guidelines/treatmentofosteoarthritisofthekneeguideli

ne.pdf. Accessed February 6, 2019.

Management of Posttraumatic Stress Disorder Work Group. VA/DoD clinical practice guideline for the

management of posttraumatic stress disorder and acute stress disorder. Version 3.0. Washington (DC):

Department of Veterans Affairs, Department of Defense; 2017 Jun. Full guideline:

https://www.healthquality.va.gov/guidelines/MH/ptsd/VADoDPTSDCPGFinal082917.pdf. Clinician

summary:

https://www.healthquality.va.gov/guidelines/MH/ptsd/VADoDPTSDCPGClinicianSummaryFinal.pdf.

Accessed February 6, 2019.

McClafferty H, Vohra S, Bailey M, et al. Pediatric integrative medicine. Pediatrics. 2017; 140(3):

e20171961; Doi: 10.1542/peds.2017-1961.

National Center for Complementary and Integrative Health. Acupuncture: in depth. National Center for

Complementary and Integrative Health (NCCIH). National Center for Complementary and Integrative

Health website. https://nccih.nih.gov/health/acupuncture/introduction. Accessed February 7, 2019.

National Certification Commission of Acupuncture and Oriental Medicine. State licensure requirements

interactive map. Updated January 1, 2018. https://www.nccaom.org/state-licensure/. Accessed

February 7, 2019.

National Institute for Health and Care Excellence. Eating disorders: recognition and treatment. NICE

guideline 69. May 23, 2017. https://www.nice.org.uk/guidance/ng69. Accessed February 6, 2019.

National Institute for Health and Care Excellence. Headaches in over 12s: diagnosis and management.

NICE clinical guideline 150. Updated November 25, 2015. http://www.nice.org.uk/guidance/cg150.

Accessed February 6, 2019.

Qaseem A, Barry MJ, Kansagara D. Nonpharmacologic versus pharmacologic treatment of adult patients

with major depressive disorder: a clinical practice guideline from the American College of Physicians.

Ann Intern Med. 2016; 164(5): 350-359. Doi: 10.7326/M15-2570.

Qaseem A, Wilt TJ, McLean RM, Forciea MA, Clinical Guidelines Committee of the American College of

Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice

guideline from the American College of Physicians. Ann Intern Med. 2017 Apr 4;166(7):514-30. Doi:

10.7326/M16-2367.

Seidman MD, Gurgel RK, Lin SY, et al. Clinical practice guideline: Allergic rhinitis. Otolaryngol Head Neck

Surg. 2015; 152(1 Suppl): S1 – 43. Doi: 10.1177/0194599814561600.

9

U.S. Food and Drug Administration. 21CFR880.5580. Acupuncture needle. Updated September 4, 2018.

https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?fr=880.5580. Accessed

February 7, 2018.

Winkelman JW , Armstrong MJ, Allen RP, et al. Practice guideline summary: treatment of restless legs

syndrome in adults: report of the Guideline Development, Dissemination, and Implementation

Subcommittee of the American Academy of Neurology. Neurology. 2016 Dec 13;87(24):2585-93. Doi:

10.1212/WNL.0000000000003388.

Peer-reviewed references:

Adams D, Cheng F, Jou H, Aung S, Yasui Y, Vohra S. The safety of pediatric acupuncture: a systematic

review. Pediatrics. 2011;128(6):e1575. Doi: 10.1542/peds.2011-1091

Brittner M, Le Pertel N, Gold MA. Acupuncture in pediatrics. Curr Probl Pediatr Adolesc Health Care.

2016;46(6):179–183pmid: 179-83. doi: 10.1016/j.cppeds.2015.12.005.

Chan YY, Lo WY, Yang SN, Chen YH, Lin JG. The benefit of combined acupuncture and antidepressant

medication for depression: A systematic review and meta-analysis. J Affect Disord. 2015; 176: 106-117.

Doi: 10.1016/j.jad.2015.01.048.

Cheong KB, Zhang JP, Huang Y, Zhang ZJ. The effectiveness of acupuncture in prevention and treatment

of postoperative nausea and vomiting — a systematic review and meta-analysis. PLoS One. 2013; 8(12):

e82474. Doi: 10.1371/journal.pone.00824.

Cherkin DC, Eisenberg D, Sherman KJ, et al. Randomized trial comparing traditional Chinese medical

acupuncture, therapeutic massage, and self-care education for chronic low back pain. Archiv intern med.

2001; 161(8): 1081-1088. Doi: 10.1001/archinte.161.8.1081.

Cui X, Zhou J, Qin Z, Liu Z. Acupuncture for erectile dysfunction: A systematic review. Biomed Res Int.

2016; 2171923. Doi: 10.1155/2016/2171923.

Davis RT, Badger G, Valentine K, Cavert A, Coeytaux RR. Acupuncture for chronic pain in the Vermont

Medicaid population: a prospective, pragmatic intervention trial. Glob Adv Health Med.

2018;7:2164956118769557. Doi:10.1177/2164956118769557

del Pino-Sedeno T, Trujillo-Martin MM, Ruiz-Irastorza G, et al. Effectiveness of nonpharmacologic

interventions for decreasing fatigue in adults with systemic lupus erythematosus: A systematic review.

Arthritis Care Res (Hoboken). 2016; 68(1): 141-148. Doi: 10.1002/acr.22675.

10

Dong W, Goost H, Lin XB, et al. Treatments for shoulder impingement syndrome: a PRISMA systematic

review and network meta-analysis. Medicine (Baltimore). 2015; 94(10): e510. Doi:

10.1097/MD.0000000000000510.

Ernst E, Lee MS, Choi TY. Acupuncture: does it alleviate pain and are there serious risks? A review of

reviews. Pain. 2011; 152(4): 755-764. Doi: 10.1016/j.pain.2010.11.004.

Feng S, Han M, Fan Y, et al. Acupuncture for the treatment of allergic rhinitis: A systematic review and

meta-analysis. Am J Rhinol Allergy. 2015; 29(1): 57-62. Doi: 10.2500/ajra.2015.29.4116.

Fernandes AC, Duarte Moura DM, Da Silva LGD, De Almeida EO, Barbosa GAS. Acupuncture in

temporomandibular disorder myofascial pain treatment: a systematic review. J Oral Facial Pain

Headache. 2017;31(3):225-232. Doi: 10.11607/ofph.1719.

Furlan AD, Yazdi F, Tsertsvadze A, et al. A systematic review and meta-analysis of efficacy, cost-

effectiveness, and safety of selected complementary and alternative medicine for neck and low-back

pain. Evid Based Complement Alternat Med. 2012; 2012: 953139. Doi: 10.1155/2012/953139.

Garcia MK, McQuade J, Haddad R, et al. Systematic review of acupuncture in cancer care: a synthesis of

the evidence. J Clin Oncol. 2013; 31(7): 952-960. Doi: 10.1200/JCO.2012.43.5818.

Gil-Martínez A, Paris-Alemany A, López-de-Uralde-Villanueva I, La Touche R. Management of pain in

patients with temporomandibular disorder (TMD): challenges and solutions. J Pain Res. 2018;11:571-

587. Doi:10.2147/JPR.S127950

Gutke A, Betten C, Degerskar K, Pousette S, Olsen MF. Treatments for pregnancy-related lumbopelvic

pain: a systematic review of physiotherapy modalities. Acta Obstet Gynecol Scand. 2015; 94(11): 1156-

1167. Doi: 10.1111/aogs.12681.

He M, Li X, Liu Y, et al. Electroacupuncture for Tinnitus: A systematic review. PLoS One. 2016; 11(3):

e0150600. Doi: 10.1371/journal.pone.0150600.

Hempel S, Taylor SL, Solloway MR, et al. Evidence Map of Acupuncture [Internet] . Washington, D.C.

Department of Veterans Affairs; 2014 January. VA-ESP Project #05-226; 2013.

https://www.ncbi.nlm.nih.gov/books/NBK185071/. Accessed February 6, 2019.

Hutchinson AJ, Ball S, Andrews JC, Jones GG. The effectiveness of acupuncture in treating chronic non-

specific low back pain: a systematic review of the literature. J Orthop Surg Res. 2012; 7: 36. Doi:

10.1186/1749-799X-7-36.

Jo J, Lee YJ, Lee H. Acupuncture for polycystic ovarian syndrome: A systematic review and meta-analysis.

Enix. D, ed. Medicine. 2017;96(23):e7066. Doi:10.1097/MD.0000000000007066.

11

Kim KH, Lee MS, Kim TH, et al. Acupuncture and related interventions for symptoms of chronic kidney

disease. Cochrane Database Syst Rev. 2016; (6): Cd009440. Doi: 10.1002/14651858.CD009440.pub2.

Kim SY, Lee H, Chae Y, Park HJ, Lee H. A systematic review of cost-effectiveness analyses alongside

randomized controlled trials of acupuncture. Acupunct Med. 2012; 30(4):273-285. Doi:

10.1136/acupmed-2012-010178.

Lam M, Galvin R, Curry P. Effectiveness of acupuncture for nonspecific chronic low back pain: A

systematic review and meta-analysis. Spine. 2013; 38(24): 2124 – 2138. Doi:

10.1097/01.brs.0000435025.65564.b7.

Lau CH, Wu X, Chung VC, et al. Acupuncture and related therapies for symptom management in

palliative cancer care: Systematic review and meta-analysis. Medicine. 2016; 95(9): e2901. Doi:

10.1097/MD.0000000000002901.

Law D, McDonough S, Bleakley C, Baxter GD, Tumilty S. Laser acupuncture for treating musculoskeletal

pain: a systematic review with meta-analysis. J Acupunct Meridian Stud. 2015; 8(1): 2-16. Doi:

10.1016/j.jams.2014.06.015.

Lee A, Chan SK, Fan LT. Stimulation of the wrist acupuncture point PC6 for preventing postoperative

nausea and vomiting. Cochrane Database Syst Rev. 2015;11(11):CD003281. Doi:

10.1002/14651858.CD003281.pub4

Lee MS, Ernst E. Acupuncture for pain: an overview of Cochrane reviews. Chin J Integr Med. 2011;

17(3):187-189. Doi: 10.1007/s11655-011-0665-7.

Lim CE, Ng RW, Xu K, et al. Acupuncture for polycystic ovarian syndrome. Cochrane Database Syst Rev.

2016; (5): Cd007689. Doi: 10.1002/14651858.CD007689.pub3.

Linde K, Allais G, Brinkhaus B, et al. Acupuncture for the prevention of tension-type headache. Cochrane

Database Syst Rev. 2016a; 4: Cd007587.(a) Doi: 10.1002/14651858.CD007587.pub2.

Linde K, Allais G, Brinkhaus B, et al. Acupuncture for the prevention of episodic migraine. Cochrane

Database Syst Rev. 2016b; 6: Cd001218.(b). Doi: 10.1002/14651858.CD007587.pub2.

Lee S-H, Lim S. Clinical effectiveness of acupuncture on Parkinson disease: A PRISMA-compliant

systematic review and meta-analysis. Pany. S, ed. Medicine. 2017;96(3):e5836.

Doi:10.1097/MD.0000000000005836.

Liddle SD, Pennick V. Interventions for preventing and treating low-back and pelvic pain during

pregnancy. Cochrane Database Syst Rev. 2015; 9: CD001139. Doi: 10.1002/14651858.CD001139.pub4.

12

Liu H, Chen L, Zhang Z, et al. Effectiveness and safety of acupuncture combined with Madopar for Parkinson’s disease: a systematic review with meta-analysis. Acupunct Med. 2017;35:404-412. Doi: 10.1136/acupmed-2016-011342.

Mangesi L, Zakarija-Grkovic I. Treatments for breast engorgement during lactation. Cochrane Database

Syst Rev. 2016; (6): Cd006946. Doi: 10.1002/14651858.CD006946.pub3.

Manyanga T, Froese M, Zarychanski R, et al. Pain management with acupuncture in osteoarthritis: a

systematic review and meta-analysis. BMC Complement Altern Med. 2014; 14: 312. Doi: 10.1186/1472-

6882-14-312.

Pennick V, Liddle SD. Interventions for preventing and treating pelvic and back pain in pregnancy.

Cochrane Database Syst Rev. 2013; 8: Cd001139. Doi: 10.1002/14651858.CD001139.pub3.

Pinto D, Robertson MC, Hansen P, Abbott JH. Cost-effectiveness of nonpharmacologic, nonsurgical

interventions for hip and/or knee osteoarthritis: systematic review. Value Health. 2012; 15(1): 1-12. Doi:

10.1016/j.jval.2011.09.003.

Qin Z, Wu J, Zhou J, Liu Z. Systematic review of acupuncture for chronic prostatitis/chronic pelvic pain

syndrome. Medicine. 2016; 95(11): e3095. Doi: 10.1097/MD.0000000000003095.

Smith CA, Armour M, Zhu X, et al. Acupuncture for dysmenorrhoea. Cochrane Database Syst Rev. 2016;

4: Cd007854. Doi: 10.1002/14651858.CD007854.pub3.

Su L, Meng L, Chen R, et al. Acupoint application for asthma therapy in adults: A systematic review and

meta-analysis of randomized controlled trials. Forsch Komplementmed. 2016; 23(1): 16-21. Doi:

10.1159/000443813.

Van den Heuvel E, Goossens M, Vanderhaegen H, Sun HX, Buntinx F. Effect of acustimulation on nausea

and vomiting and on hyperemesis in pregnancy: a systematic review of Western and Chinese literature.

BMC Complement Altern Med. 2016; 16: 13. Doi: 10.1186/s12906-016-0985-4.

Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: individual patient data meta-

analysis. Arch Intern Med. 2012; 172(19): 1444 – 1453. Doi: 10.1001/archinternmed.2012.3654.

Vickers AJ, Vertosick EA, Lewith G, et al. Acupuncture for chronic pain: Update of an individual; patient

data meta-analysis. J Pain. 2017; pii: S1526-5900(17)30780-0. Doi: 10.1016/j.jpain.2017.11.005.

Wu JY, Zhang C, Xu YP, et al. Acupuncture therapy in the management of the clinical outcomes for

temporomandibular disorders: A PRISMA-compliant meta-analysis. Medicine. 2017;96(9):e6064. Doi:

10.1097/md.0000000000006064.

13

Wu MS, Chen KH, Chen IF, et al. The efficacy of acupuncture in post-operative pain management: a

systematic review and meta-analysis. PLoS One. 2016; 11(3): e0150367. Doi:

10.1371/journal.pone.0150367.

Yang A, Wu HM, Tang JL, et al. Acupuncture for stroke rehabilitation. Cochrane Database Syst Rev. 2016;

(8): Cd004131. Doi: 10.1002/14651858.CD004131.pub3.

Yang C, Hao Z, Zhang LL, Guo Q. Efficacy and safety of acupuncture in children: an overview of systematic reviews. Pediatr Res. 2015;78(2):112–119. Doi: 10.1038/pr.2015.91.

Yuan QL, Guo TM, Liu L, Sun F, Zhang YG. Traditional Chinese medicine for neck pain and low back pain:

a systematic review and meta-analysis. PLoS One. 2015; 10(2): e0117146. Doi:

10.1371/journal.pone.0117146.

Zhang Q, Yue J, Golianu B, Sun Z, Lu Y. Updated systematic review and meta-analysis of acupuncture for

chronic knee pain. Acupunct Med. 2017;35(6):392-403. Doi: 10.1136/acupmed-2016-011306.

Zhou J, Peng W, Xu M, Li W, Liu Z. The effectiveness and safety of acupuncture for patients with

Alzheimer disease: a systematic review and meta-analysis of randomized controlled trials. Medicine

(Baltimore). 2015; 94(22): e933. Doi: 10.1097/MD.0000000000000933.

Centers for Medicare and Medicaid Services National Coverage Determinations:

30.3 Acupuncture.

30.3.1 Acupuncture for Fibromyalgia.

30.3.2 Acupuncture for Osteoarthritis.

10.3 Inpatient Hospital Pain Rehabilitation Programs.

10.4 Outpatient Hospital Pain Rehabilitation Programs.

Local Coverage Determinations:

A55240 Auricular Peripheral Nerve Stimulation (Electro-Acupuncture Device).

Commonly submitted codes

Below are the most commonly submitted codes for the service(s)/item(s) subject to this policy. This is

not an exhaustive list of codes. Providers are expected to consult the appropriate coding manuals and

bill accordingly.

CPT Code Description

Comments

97810 Acupuncture, 1 or more needles; without electrical stimulation, initial 14 minutes of personal one-on-one contact with the patient

14

97811 Acupuncture, 1 or more needles, without electrical stimulation, each additional 15 minutes of personal one-on-one contact, with re-insertion of needle(s)

97813 Acupuncture, 1 or more needles; with electrical stimulation, initial 14 minutes of personal one-on-one contact with the patient

97814 Acupuncture, 1 or more needles, with electrical stimulation, each additional 15 minutes of personal one-on-one contact, with re-insertion of needle(s)

ICD-10 Code Description Comments

G43.01-G43.919 Migraine

G43.701-G43.719 Chronic migraine

G89.12 Acute postprocedural thoracotomy pain

G89.18 Other acute postprocedural pain

G89.22 Chronic postprocedural thoracotomy pain

G89.28 Other chronic postprocedural pain

G89.29 Other chronic pain

G89.0 Central pain syndrome

G89.4 Chronic pain syndrome

M17.0-M17.9 Osteoarthritis - knee

M25.561-M25,569 Pain in knee

M26.201-M26.69 Temporomandibular joint disorders

M54.40-M54.5 Lower back pain

R11.0-R11.2 Nausea and vomiting

R51 Headache

T45.1X5 Adverse effect of antineoplastic and immunosuppressive drugs

T80.89X Other complications following infusion, transfusion or therapeutic injection

Z92.21 Personal history of antineoplastic chemotherapy

HCPCS Level II

Description Comments

S8930 Electrical stimulation of auricular acupuncture points; each 15 minutes of personal one-hyphenon-hyphenone contact with the patient