Acupuncture (97810-97814) is not recognized as an eligible service.  Coverage for acupuncture is determined according to individual or group customer benefits.

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Acupuncture is eligible in accordance with the following requirements:

1. Benefits may be provided for the anesthesia by acupuncture if it is administered in accordance with all contract requirements concerning anesthesia (i.e., it must be ordered by the attending physician in connection with covered surgery, obstetrical procedures, or shock therapy and administered by a physician other than the attending physician or his/her assistant).
   
   
2. When acupuncture is performed as therapy either on an inpatient or outpatient basis, medical benefits apply if the service was performed by a physician acting within the scope of his or her license and it is determined by medical review that the therapy was effective treatment.  Otherwise, benefits should be denied.
   
   
3. Claims reporting supervision or medical direction of anesthesia care should be processed according to the guidelines issued in Medical Policy Bulletin A-3.

For services provided on or after 1/1/06, acupuncture is covered when performed by a licensed acupuncturist.