Unfortunately, We do not accept Health Insurance
Acupuncture insurance coverage in Utah varies from plan to plan. Although we used to work with insurance companies in the past, we have found that they do not cover as many visits as needed and patients have ended up owing a lot of money by forcing you to pay out of pocket.
However, we have an affordable plan that will allow you to get the treatment you need without worrying about your insurance leaving you helpless. For more information about our affordable plans, please contact our office!
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Insurance Hindsight
Please Check with A Professional / Licensed Health Insurance Agent to Learn more About Your Acupuncture Insurance Coverage In Utah
Chronic back pain, acute lower back pain are the most common disorder in the world. 39% of acute lower back pain would appear in adults, contributing to disability both physical hurt and mental distress. Acute lower back pain can affect a patient’s ability to work, socialize, sleep as well as contribute to depression, reduce range motion and decrease in any physical activity.
Acupuncture treatment for back pain has proven its effectiveness from a long history of use in China. The insertion of needles at the acupoints activate the energy beneath the skin, connect the spinal pathway systems. This pain pathway is responsible for all your pain, blockage of energy cause disturbing in this connection.
MEDICARE ADVANTAGE PLAN
Acupuncture Insurance coverage In Utah for chronic lower back pain
Since January 2020, the Centers for Medicare & Medicaid Services (CMS) covers Acupuncture Insurance Coverage In Utah only for Medicare patients with Chronic Lower Back Pain (cLBP).
Who may perform acupuncture for cLBP?
Physicians, in accordance with state requirements and physician assistants, nurse practitioners/clinical nurse specialists, and auxiliary personnel who meet all applicable state requirements and have:
- A master’s or doctoral degree in acupuncture or oriental medicine from a school accredited by the Accreditation Commission for Acupuncture and Oriental Medicine
- A current, full, active, and unrestricted license to practice acupuncture in a state, territory, or commonwealth of the United States, or in the District of Columbia
Read about state requirements in the Social Security Act 1861 Part E-Miscellaneous Provisions for physicians, physician assistants, nurse practitioners/clinical nurse specialists and auxiliary personnel.
Auxiliary personnel furnishing acupuncture must be under the supervision of a physician, physician assistant, or nurse practitioner/clinical nurse specialist.
Requirements are included in our provider and facility participation criteria.
What is covered?
In the new Acupuncture Insurance Coverage In Utah policy,
CMS covers up to 12 visits in 90 days for cLBP when the pain:
- Lasts 12 weeks or longer
- Is nonspecific (no identifiable systemic cause; not associated with metastatic, inflammatory or infectious disease)
- Is not associated with surgery or pregnancy
A patient may receive:
- Eight additional sessions improvement
- No more than 20 acupuncture treatments annually
- Treatment must stop if the patient not improving or regresses
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Learn More about Your Benefits
For the Acupuncture Insurance Coverage In Utah, Some Blue Cross health plans cover acupuncture when it is medically necessary and prescribed by your doctor. Your doctor may prescribe acupuncture to treat:
- Chronic pain that has lasted at least six months and did not respond to more conservative forms of treatment, like drugs or physical therapy
- Nausea due to surgery or chemotherapy
Standard Aetna plans to extend the coverage of Acupuncture Insurance Coverage In Utah for medically necessary indications when administered by a health care provider practicing within the scope of his/her license.
Some Aetna plans limit coverage of Acupuncture Insurance Coverage In Utah to when it is used in a lieu of other anesthesia for a surgical or dental procedure covered under the health benefits plan, and the health care provider administering it is a legally qualified physician practicing within the scope of his/her license.
Some other plans may extend acupuncture insurance coverage in Utah for medically necessary indications, but only when administered by a health care provider who is a legally qualified physician practicing within the scope of his/her license. Please check benefit plan descriptions for details.
Aetna considers needle 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).
Maintenance treatment, where the member’s symptoms are neither regressing or improving, is considered not medically necessary.
If no clinical benefit is appreciated after four weeks of acupuncture, then the treatment plan should be reevaluated. Further acupuncture treatment is not considered medically necessary if the member does not demonstrate meaningful improvement in symptoms.
Aetna considers acupuncture experimental and investigational for all other indications, including but not limited to any of the following conditions, because there is inadequate scientific research assessing the efficacy of acupuncture compared with placebo, sham acupuncture, or other modalities of treatment in these conditions: [Read more]
Aetna considers acupuncture point injection (also known as acupoint injection therapy, biopuncture) experimental and investigational for the following conditions (not an all-inclusive list) because the effectiveness of this approach has not been established:
- Amyotrophic lateral sclerosis.
- Cancer-related pain
- Cervical spondylosis
- Chronic daily headache
- Dysmenorrhea (menstrual pain)
- Lateral elbow pain (tennis elbow).
Aetna considers dry needling experimental and investigational because of inadequate evidence of its effectiveness.
Description |
We address the use of acupuncture to our Acupuncture Insurance Coverage In Utah which is the practice of stimulating specific points on the body using needles for the purpose of treating various health conditions. Manual manipulation or electrical stimulation of the needles may or may not be incorporated into therapy.
Note: For additional information regarding the use of auricular electroacupuncture, please see:
Clinical Indications |
Medically Necessary:
The use of acupuncture is considered medically necessary for the treatment of nausea and vomiting associated with surgery, chemotherapy, or pregnancy.
The use of acupuncture is considered medically necessary for treatment of painful chronic osteoarthritis of the knee or of the hip that is significantly affecting daily activity.
Not Medically Necessary:
Acupuncture is considered not medically necessary when the criteria above are not met, and for any other indication.
Coding |
The following codes for treatments and procedures applicable to this document are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member’s contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.
When services may be Medically Necessary when criteria are met:
CPT | ||
97810 | Acupuncture, 1 or more needles; without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient | |
97811 | Acupuncture, 1 or more needles; without electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) | |
97813 | Acupuncture, 1 or more needles; with electrical stimulation, initial 15 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 the patient, with re-insertion of needle(s) | |
ICD-10 Procedure | ||
8E0H30Z | Acupuncture | |
ICD-10 Diagnosis | ||
All diagnoses | ||
When services are Not Medically Necessary:
For the procedure codes listed above when criteria are not met, for the following procedure code, or when the code describes a procedure designated in the Clinical Indications section as not medically necessary.
ICD-10 Procedure | |
8E0H300 | Acupuncture using anesthesia |
ICD-10 Diagnosis | |
All diagnoses |
Description |
Acupuncture insurance coverage in Utah is subject to the terms, conditions, and limitations of the benefits as described in the applicable plan’s schedule of copayments. Please refer to the applicable benefit plan document to determine benefit availability and the terms and conditions of coverage
Guidelines |
Medically Necessary
If coverage for acupuncture services are available in the applicable benefit plan document, Acupuncture Insurance Coverage In Utah may be provided as treatment for ANY of the following conditions when ALL of the medical necessity factors and ALL of the treatment planning /outcomes listed below are met:
- Tension-type Headache; Migraine Headache with or without Aura
- Musculoskeletal joint and soft tissue pain (e.g., hip, knee, spine) resulting in a functional deficit (e.g., inability to perform household chores, interference with job functions, loss of range of motion)
- Nausea Associated with Pregnancy (only when co-managed)
- Post-Surgical Nausea (only when co-managed) Acupuncture (CPG 024)
- Nausea Associated with Chemotherapy; (only when co-managed)
Medical Necessity Factors:
- Medically necessary services must be delivered toward defined reasonable and evidence-based goals;
- Medical necessity decisions must be based on patient presentation including diagnosis, severity, and documented clinical findings;
- Continuation of treatment is contingent upon progression towards defined treatment goals and evidenced by specific significant objective functional improvements (e.g., outcome assessment scales, range of motion)
- Certain conditions require that the patient is being co-managed by a medical physician in order to be considered medically necessary;
- Medically necessary services include monitoring of outcomes and progress with a change in treatment or withdrawal of treatment if the patient is not improving or is regressing.
Treatment Planning/Outcome Factors:
- An individualized treatment plan (e.g., frequency and duration of service) is appropriately correlated with clinical findings and clinical evidence;
- Treatment is expected to result in significant therapeutic improvement over a clearly defined period of time;
- Therapeutic goals are functionally oriented, realistic, measurable, and evidence-based;
- The proposed date of release/discharge from treatment is estimated;
- Functional Outcome Measures (FOM), when used, demonstrates Minimal Clinically Important Difference (MCID) from baseline results through periodic re-assessments;
- Documentation substantiates practitioner’s diagnosis and treatment plan;
- Demonstration of progression toward active home/self-care and discharge, and;
- Maximum therapeutic benefit has not been reached
Description |
- There are some alternative treatments that your health plan may cover. Acupuncture and chiropractic care may be covered if they’re medically necessary. Many plans include physical therapy, and if massage therapy is determined a part of your therapy, it could be covered, too.
- The best way to find out what’s covered in Acupuncture Insurance Coverage In Utah Policy is to take a look at your plan details. Sign in at regence.com, and select My benefits. Your Medical Benefits Booklet outlines what kind of treatments are covered under your plan.If you have further questions—like if you’ll need a prescription, or if you’re limited to a number of visits—reach out to Customer Service.
Billing Indications |
All claims must include both the International Classification of Diseases, Ninth Revision (ICD-9), and Current Procedural Terminology (CPT® ) codes to ensure accurate processing. The diagnosis must match the diagnosis of the referring physician.
When billing for acupuncture services, please use:
The following codes for treatments and procedures applicable to this document are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis, or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member’s contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.
CPT | ||
97810 | Acupuncture, one or more needles; without electrical stimulation, initial 15 minutes of personal one on one contact with the patient | |
97811 | Acupuncture, one or more needles; without electrical stimulation, each additional 15 minutes of personal one on one contact with the patient, with reinsertion of needle(s) (List separately in addition to code for primary procedure) | |
97813 | Acupuncture, one or more needles; with electrical stimulation, each additional 15 minutes of personal one on one contact with the patient | |
97814 | Acupuncture, one or more needles; with electrical stimulation, each additional 15 minutes of personal one on one contact with the patient, with reinsertion of needle(s) (List separately in addition to code for primary procedure) | |
97810 97813 | will not be allowed when billed together for the same visit. | |
97810 97813 | Only one unit of service is allowed per date of service, up to the benefit maximum. | |
97811 97814 | Must be explicitly denoted in the patient’s medical record to be allowed | |
8 Minute Rule for Timed Codes – One Service
For services billed in 15-minute units, count the minutes of skilled treatment provided.
Only direct, face-to-face time with the patient is considered for timed codes.
- 7 minutes or less of a single service is not billable.
- 8 minutes or more of a single service is billable as 1 unit or an additional unit if the prior units were each furnished for a full one.
15 minutes:
- 8 – 22 minutes = 1 unit
- 23 – 37 minutes = 2 units
- 38 – 52 minutes = 3 units
Note: Evaluation and management (E&M) codes cannot be used as a substitute for acupuncture treatments.
Acupuncture for the treatment of chemical dependency
A participating acupuncturist/east Asian medicine practitioner will be reimbursed for acupuncture services provided for chemical dependency treatment when the member’s plan includes a benefit for both acupuncture services and chemical dependency treatment.
Acupuncture treatment for chemical dependency is covered in the following instances:
- When the member’s plan covers acupuncture
- Diagnosis supports chemical dependency benefits
- When smoking cessation is covered under some plans
- If required by the member’s plan, a referral by the member’s primary care physician or by the contracted behavioral health department organization has been filed with Regence
#1 Best Acupuncture in Utah County
You’re in good hands
Dan Clark has been practicing acupuncture for infertility treatment for 20+ years and he is also specialized in Traditional Chinese Medicine to address your acute back pain concern.
At Lotus Spring Acupuncture & Wellness Inc, Dan designs a specific care package for any individual. Many patients left Dan with good impressions on the effectiveness of his treatments and his professional style, Dan knows how to make his patients feel informed and comfortable.