Highmark Medical Policy Bulletin
Section: Miscellaneous
Number: Z-14
Topic: Acupuncture
Effective Date: August 28, 2000
Issued Date: November 1, 2003
Date Last Reviewed:

General Policy Guidelines

Indications and Limitations of Coverage

Acupuncture is not recognized as an eligible service. Coverage for Acupuncture is determined according to individual or group customer benefits.

Procedure Codes

9778097781    

Traditional (UCR/Fee Schedule) Guidelines

Refer to General Policy Guidelines

FEP Guidelines

Acupuncture is eligible in accordance with the following requirements:

  1. Benefits may be provided for 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 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 or physical therapist 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.

Comprehensive / Wraparound / PPO / Major Medical Guidelines

Refer to General Policy Guidelines

Managed Care (HMO/POS) Guidelines

Refer to General Policy Guidelines

Publications

References

View Previous Versions

[Version 001 of Z-14]

Table Attachment

Text Attachment

Procedure Code Attachment


Glossary




Medical policies do not constitute medical advice, nor are they intended to govern the practice of medicine. They are intended to reflect Highmark's reimbursement and coverage guidelines. Coverage for services may vary for individual members, based on the terms of the benefit contract.

Highmark retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of Highmark. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.