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kellyilseman
Apr 24 min read

Insurance Coverage for Acupuncture in Oregon

The following is an except from Acupuncture for Pain Management; the full document that can be found here. This excerpt details insurance coverage for acupuncture in Oregon.



1. Oregon Health Plan (OHP) Oregon Health Plan (OHP) Benefits: Physical Health Care. Published N.D. Accessed November 25, 2023. https://www.oregon.gov/oha/hsd/ohp/pages/benefits.aspx (107)

Prioritized List of Health Services. Oregon.gov/oha. Published October 1, 2023. Accessed November 25, 2023. https://www.oregon.gov/oha/hpa/dsi-herc/pages/prioritized-list.aspx (108)

  • The Oregon Health Plan (OHP), a medicaid program run by the Oregon Health Authority, covers regular acupuncture visits “to reduce pain and symptom burden” for the following conditions:

  • conditions of the back and spine

  • scoliosis

  • osteoarthritis of the knee

  • migraine headaches

  • tension headaches

  • symptoms from multiple types of cancer (various comprehensive body systems)

  • conditions of pregnancy (hyperemesis gravidarum, breech, and back/pelvic pain)

  • substance use

  • behavioral health conditions related to substance use

  • post-stroke depression

  • HIV+ status

  • palliative care pain and symptom relief

  • Twelve visits are offered initially, with subsequent visits approved via prior authorization based on medical necessity. 

2. Regence BC/BS Access alternative medicine with help from your health plan. Regence.com. Updated 2023. Accessed November 26, 2023.https://www.regence.com/member/understanding-health-insurance/alt-medicine (109)

  • Many Regence Blue Cross/Blue Shield plans cover medically necessary acupuncture services.

3. United Healthcare Acupuncture Policy, Professional. UHCHealthcare. Updated 2023. Accessed November 26,2023.https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-reimbursement/COMM-Acupuncture-Policy.pdf (110)

  • Many United Healthcare plans offer acupuncture benefits. 

4. Providence Your Benefits Summary. Providence.org. Published N.D. Accessed November 26, 2023.https://phpcws.providence.org/phpcws/DocsNew/9ALP0039.pdf (111)

  • Providence covers acupuncture when it is “medically necessary for the treatment of neuromusculoskeletal disorders, nausea or pain.”

5. Pacific Source Chiropractic Manipulation and Acupuncture. PacificSource.com. Published N.D. Accessed November 26, 2023.https://pacificsource.com/sites/default/files/plans/2020/CustomGroup/BCOC_Chiropractic%20Manipulation%20and%20Acupuncture_1000_0120.pdf (112)

  • PacificSource insurance “allows you to receive services from licensed providers for chiropractic manipulation and acupuncture care for medically necessary treatment of illness or injury.”

6. Kaiser Complementary and Alternative Medicine. KaiserPermanente.org. Updated 2023. Accessed November 26, 2023. https://wa-provider.kaiserpermanente.org/provider-manual/patient-care/specialty/alternative (113)

  • “Most plans cover a limited number of self-referred acupuncture, naturopathy, and manipulative therapy visits.” 

7. MODA Acupuncture. Modahealth.com. Published January 2019. Accessed November 26, 2023. https://www.modahealth.com/pdfs/med_criteria/Acupuncture.pdf (114)

  • Covers 10-20 acupuncture or electroacupuncture visits within 2 months “when it is listed as a covered benefit and is administered by a healthcare provider who is a legally qualified acupuncturist practicing within the scope of his/her license for the following indications:”

  • nausea and vomiting associated with: postoperative nausea and vomiting, chemotherapy, pregnancy

  • postoperative dental pain

  • temporomandibular disorders

  • chronic painful conditions: neck pain, back pain, and osteoarthritic knee or hip pain.”

8. CHPIntegrative Healthcare Services. CHPgroup.com. Published 2022. Accessed November 26, 2023. https://chpgroup.com/ (115)

  • The CHP group lists acupuncture as one of the integrative healthcare services offered by many of its plans.

9. Aetna (ASH)Acupuncture and Dry Needling. Aetna.com. Last Reviewed April 5, 2023. Accessed November 26, 2023.https://www.aetna.com/cpb/medical/data/100_199/0135.html (116)

  • “Aetna considers acupuncture (manual or electroacupuncture) medically necessary for any of the following indications:

  • Chronic (minimum 12 weeks duration) neck pain; or

  • Chronic (minimum 12 weeks duration) headache; or

  • Low back pain; or

  • Nausea of pregnancy; or

  • Pain from osteoarthritis of the knee or hip (adjunctive therapy); or

  • Post-operative and chemotherapy-induced nausea and vomiting; or

  • Post-operative dental pain; or

  • Temporomandibular disorders (TMD).”

10. Cigna (ASH)Cigna Medical Coverage Policy- Therapy Services Acupuncture. Cigna.com. Updated 2023. Accessed November 26, 2023. https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/CPG024_acupuncture.pdf (117)

  • Cigna covers acupuncture when medically necessary for the following conditions: 

  • tension headaches

  • migraine headaches with or without aura

  • musculoskeletal joint and soft tissue pain (including hip, knee, spine) “resulting in a functional deficit (e.g., inability to perform household chores, interference with job functions, loss of range of motion),”

  • Cigna covers acupuncture to treat the following conditions when they are co-managed:

  • nausea related to pregnancy

  • post-surgical nausea

  • nausea due to chemotherapy


11. Triwest  Veteran Eligibility and Covered Services. TriWest.com. Published 2023. Accessed November 26, 2023. https://www.triwest.com/en/provider-handbook/veteran-eligibility-and-covered-services/ (118)

  • TriWest (Veterans’ Affairs) lists acupuncture as one of their covered member services.    

12. Health Net Alternative Care. HealthNetOregon.com. Published 2023. Accessed November 26, 2023. https://www.healthnetoregon.com/employers/supplemental-coverage/alternative-care-providers.html (119)

  • HealthNet offers acupuncture “coverage on most plans.” 

13. Humana Take Advantage of Valuable Extras. Humana.com. Updated October 31, 2023. Accessed November 26, 2023. https://www.humana.com/member/discounts (120)

Does Humana Cover Acupuncture? Published October 05, 2023. Accessed November 26, 2023. https://www.helpadvisor.com/medicare/does-humana-cover-acupuncture (121)

  • Acupuncture is covered as one of the services covered by Humana. For medicare patients, 12-20 acupuncture visits for low back pain are covered per calendar year. 


It is worth noting that as of January 1, 2022, acupuncture is considered an essential health benefit in Oregon, and insurance companies are required to cover at least 12 visits. (122)




References

107. Oregon Health Plan (OHP) Benefits: Physical Health Care. Published N.D. Accessed November 25, 2023. https://www.oregon.gov/oha/hsd/ohp/pages/benefits.aspx

108. Prioritized List of Health Services. Oregon.gov/oha. Published October 1, 2023. Accessed November 25, 2023. https://www.oregon.gov/oha/hpa/dsi-herc/pages/prioritized-list.aspx  109. Access alternative medicine with help from your health plan. Regence.com. Updated 2023. Accessed November 26, 2023.https://www.regence.com/member/understanding-health-insurance/alt-medicine 110. Acupuncture Policy, Professional. UHCHealthcare. Updated 2023. Accessed November 26, 2023.https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-reimbursement/COMM-Acupuncture-Policy.pdf 111. Your Benefits Summary. Providence.org. Published N.D. Accessed November 26, 2023.https://phpcws.providence.org/phpcws/DocsNew/9ALP0039.pdf 112. Chiropractic Manipulation and Acupuncture. PacificSource.com. Published N.D. Accessed November 26, 2023.https://pacificsource.com/sites/default/files/plans/2020/CustomGroup/BCOC_Chiropractic%20Manipulation%20and%20Acupuncture_1000_0120.pdf 113. Complementary and Alternative Medicine. KaiserPermanente.org. Updated 2023. Accessed November 26, 2023. https://wa-provider.kaiserpermanente.org/provider-manual/patient-care/specialty/alternative 114. Acupuncture. Modahealth.com. Published January 2019. Accessed November 26, 2023. https://www.modahealth.com/pdfs/med_criteria/Acupuncture.pdf 115. Integrative Healthcare Services. CHPgroup.com. Published 2022. Accessed November 26, 2023. https://chpgroup.com/

116. Acupuncture and Dry Needling. Aetna.com. Last Reviewed April 5, 2023. Accessed November 26, 2023.https://www.aetna.com/cpb/medical/data/100_199/0135.html 117. Cigna Medical Coverage Policy- Therapy Services Acupuncture. Cigna.com. Updated 2023. Accessed November 26, 2023. https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/CPG024_acupuncture.pdf 118. Veteran Eligibility and Covered Services. TriWest.com. Published 2023. Accessed November 26, 2023. https://www.triwest.com/en/provider-handbook/veteran-eligibility-and-covered-services/ 119. Alternative Care. HealthNetOregon.com. Published 2023. Accessed November 26, 2023. https://www.healthnetoregon.com/employers/supplemental-coverage/alternative-care-providers.html 120. Take Advantage of Valuable Extras. Humana.com. Updated October 31, 2023. Accessed November 26, 2023. https://www.humana.com/member/discounts 121. Does Humana Cover Acupuncture? Published October 05, 2023. Accessed November 26, 2023. https://www.helpadvisor.com/medicare/does-humana-cover-acupuncture

122.  Oregon Department of Consumer and Business Services. Insurance Regulation - Chapter 836, Division 53 - Health Benefit Plans. “836-053-0017 Additions to Essential Health Benefits for Plan Years Beginning on or after January 1, 2022. Accessed March 31, 2024, from https://secure.sos.state.or.us/oard/displayDivisionRules.action?selectedDivision=3778. 

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