National Medical Policy

National Medical Policy
Policy Number:
Effective Date*:
October 2003
April 2006, April 2008, October 2009,
November 2009, March 2011, November
2011, October 2012, October 2013
This National Medical Policy is subject to the terms in the
at the end of this document
For Medicaid Plans: Please refer to the appropriate Medicaid Manuals for
coverage guidelines prior to applying Health Net Medical Policies
The Centers for Medicare & Medicaid Services (CMS)
For Medicare Advantage members please refer to the following for coverage
guidelines first:
National Coverage Determination
Reference/Website Link
Acupuncture for Fibromylagia:
Acupuncture for Osteoarthritis:
Acupuncture Oct 13
Inpatient Hospital Pain Rehabilitation Programs:
Outpatient Hospital Pain Rehabilitation
National Coverage Manual Citation
Local Coverage Determination
Article (Local)*
Non Covered Services:
Use Health Net Policy
 Medicare NCDs and National Coverage Manuals apply to ALL Medicare members
in ALL regions.
 Medicare LCDs and Articles apply to members in specific regions. To access your
specific region, select the link provided under “Reference/Website” and follow the
search instructions. Enter the topic and your specific state to find the coverage
determinations for your region. *Note: Health Net must follow local coverage
determinations (LCDs) of Medicare Administration Contractors (MACs) located
outside their service area when those MACs have exclusive coverage of an item
or service. (CMS Manual Chapter 4 Section 90.2)
 If more than one source is checked, you need to access all sources as, on
occasion, an LCD or article contains additional coverage information than
contained in the NCD or National Coverage Manual.
Acupuncture Oct 13
If there is no NCD, National Coverage Manual or region specific LCD/Article,
follow the Health Net Hierarchy of Medical Resources for guidance.
Current Policy Statement
Please refer to the applicable benefit plan document to determine
benefit availability and the terms, conditions and limitations of
coverage for acupuncture
Health Net, Inc. considers acupuncture medically necessary for any of the following
Chronic low back pain; or
Chronic pain associated with osteoarthritis as adjuvant therapy; or
Nausea & vomiting associated post-operative procedures, chemotherapy or
pregnancy; or
Migraine headache.
Health Net, Inc. considers acupuncture investigational for all other indications,
including but not limited to any of the following conditions, because although studies
are still being done, there is inadequate scientific peer-reviewed research assessing
the safety, efficacy and long-term outcomes of acupuncture compared with other
modalities of treatment in these conditions:
Acute low back pain
Carpal tunnel syndrome
Fetal breech presentation
Hot flashes
Induction of labor
Irritable bowel syndrome
Maintenance treatment, where the patient’s pain symptoms are not improving
Menstrual cramps/dysmenorrhea
Myofascial pain
Neck pain/cervical spondylosis
Parkinson's disease
Post-herpetic neuralgia
Psychiatric disorders (e.g., depression)
Shoulder pain (e.g., bursitis)
Stroke rehabilitation (e.g., dysphagia)
Tension headache
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Urinary incontinence
Chronic obstructive pulmonary disease (COPD)
Health Net, Inc. considers acupuncture not medically necessary for any of the
following indications, as the available scientifically based data fails to demonstrate
improved patient outcomes in the medical literature:
Cancer-related dyspnea
Chemotherapy-induced leucopenia
Chronic pain syndrome (e.g., RSD, facial pain)
Fibrotic contractures
In lieu of traditional anesthesia
Painful neuropathies
Peripheral arterial disease (e.g., intermittent claudication)
Phantom leg pain
Raynaud’s disease pain
Rheumatoid arthritis
Sensorineural deafness
Smoking cessation
Tennis elbow/epicondylitis
Weight loss
Codes Related To This Policy
The codes listed in this policy are for reference purposes only. Listing of a code in
this policy does not imply that the service described by this code is a covered or noncovered health service. Coverage is determined by the benefit documents and
medical necessity criteria. This list of codes may not be all inclusive.
On October 1, 2014, the ICD-9 code sets used to report medical diagnoses and
inpatient procedures will be replaced by ICD-10 code sets. Health Net National
Medical Policies will now include the preliminary ICD-10 codes in preparation for this
transition. Please note that these may not be the final versions of the codes and
that will not be accepted for billing or payment purposes until the October 1, 2014
implementation date.
ICD-9 Codes
List may not be all-inclusive
Chronic tension-type headache
Migraine headache
350.1-350.9 Trigeminal neuralgia
643.00Excessive vomiting in pregnancy
Osteoarthritis, generalized
Osteoarthrosis, generalized
Lumbar disc protrusion
Synovitis and Tendonitis
Myalgia and myositis, unspecified
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Nausea with vomiting [postoperative] [chemotherapy-induced]
Adverse effect of antineoplastic and immunosuppressive drugs
[chemotherapy-induced nausea and vomiting]
ICD-10 Codes
G43.001G43. 919
Tension type headache
Post traumatic headache
Trigeminal Neualgia
Rheumatoid arthritis, unspecified
Other and unspecified Dorsopathies, not elsewhere classified
Myositis, unspecified
Other synovitis and tenosynovitis
Myalgia, neuralgia and neuritis, unspecified
Excessive vomiting in pregnancy
Nausea and vomiting
CPT Codes
Acupuncture one or more needles without electrical stimulation
(deleted 12/31/04)
Acupuncture one or more needles with electrical stimulation
(deleted 12/31/04)
Acupuncture, one or more needles, w/o electric stimulation; initial 15
minutes of personal one-one contact with the patient.
Acupuncture, one or more needles, w/o electric stimulation; each
additional 15 minutes of personal one-one contact with the patient
with re-insertion of needles.
Acupuncture, one or more needles, with electric stimulation; initial 15
minutes of personal one-one contact with the patient.
Acupuncture, one or more needles, with electric stimulation; each
additional 15 minutes of personal one-one contact with the patient,
with re-insertion of the needle(s).
Scientific Rationale – Update October 2013
Chronic obstructive pulmonary disease (COPD), a common disease characterized by
irreversible airflow limitation, is predicted to be the third leading cause of death
Acupuncture Oct 13
worldwide by 2020. Dyspnea, the most fundamental and debilitating symptom of
COPD, is associated with considerable disease burden, affecting many aspects of
everyday life. The severity of dyspnea generally progresses over time in patients
with COPD, and dyspnea has been found to be predictive of survival in COPD.
Therefore, the management of dyspnea is one of the most important targets in the
treatment of COPD.
There is good evidence to support relief of dyspnea by pulmonary rehabilitation,
although most studies include primarily or exclusively patients with COPD.
Pulmonary rehabilitation includes exercise training, psychosocial support, nutrition
therapy, and self-management strategies, such as diaphragmatic and pursed lip
breathing. Pulmonary rehabilitation may also improve exercise tolerance and
psychological parameters among patients with lung cancer, although results are
preliminary. Pulmonary rehabilitation might not be appropriate for patients with a
short estimated life expectancy.
Acupuncture has been examined as a potential therapy to reduce dyspnea with
mixed results in retrospective studies, case reports and small randomized trials. The
studies have concluded that the evidence is inadequate to recommend acupuncture
as a routine intervention for dyspnea control in patients with COPD. The studies have
been primarily short-term with inadequate determinations of long-term safety or
Ngai et al. (2013) completed a case report on a 74 year old man, admitted to a
hospital after an acute exacerbation of COPD. Treatment consisted of 45 minutes of
transcutaneous electrical nerve stimulation over acupuncture points (Acu-TENS), a
noninvasive intervention that has recently been shown to alleviate dyspnea in
patients with stable chronic obstructive pulmonary disease (COPD). Oxygen
saturation, heart rate, and dyspnea score were measured before, immediately after,
and 45 minutes after Acu-TENS intervention. Other than the physiologic measures,
10mL of venous blood was taken from the cubital vein for assessment of β-endorphin
level, white blood cell count, tumor necrosis factor-α (TNF-α), and C-reactive protein
(CRP) level before and immediately postintervention. Postintervention, improved
oxygen saturation, and reduction in heart rate and dyspneic sensation were observed
accompanied by a raised blood β-endorphin level but the level of white blood cell
count, TNF-α, and CRP remain unchanged. Application of 45 minutes Acu-TENS
appeared to alleviate symptoms in a patient with AECOPD. The role of adjunctive
Acu-TENS therapy during acute exacerbation of COPD warrants further investigation.
Suzuki et al. (2012) completed a double-blinded randomized, parallel-group,
placebo-controlled trial. Sixty-eight of 111 patients who were diagnosed as having
COPD and were receiving standard medication participated in this RCT (July 1, 2006,
through March 31, 2009). Participants were randomly assigned to traditional
acupuncture (real acupuncture group, n=34) or placebo needling (placebo
acupuncture group, n=34). Both groups received real or placebo needling at the
same acupoints once a week for 12 weeks. The primary end point was the modified
Borg scale score evaluated immediately after the 6-minute walk test. Measurements
were obtained at baseline and after 12 weeks of treatment. After 12 weeks, the Borg
scale score after the 6-minute walk test was significantly better in the real
acupuncture group compared with the placebo acupuncture group (mean [SD]
difference from baseline by analysis of covariance, -3.6 [1.9] vs 0.4 [1.2]; mean
difference between groups by analysis of covariance, -3.58; 95% CI, -4.27 to -2.90).
Acupuncture Oct 13
Patients with COPD who received real acupuncture also experienced improvement in
the 6-minute walk distance during exercise, indicating better exercise tolerance and
reduced DOE. This study notes that acupuncture is a promising adjunctive therapy in
reducing DOE in patients with COPD. However, it was a short-term study only with
follow-up at 12 weeks. Additional studies with long-term follow-up are necessary to
determine if acupuncture really shows improvement in COPD patients over a more
substantial period of time.
Deering et al. (2011) completed a randomized prospective study in which all subjects
had COPD. There were 19 controls, 25 who underwent pulmonary rehabilitation (PR),
and 16 who had both acupuncture and PR. The primary outcome measure was a
change in measures of systemic inflammation at the end of PR and at 3 month
followup. Lung function, including maximum inspiratory pressure (PiMax), quality-oflife scores, functional capacity including steps taken, dyspnea scores, and exercise
capacity, were secondary endpoints. After PR, both groups had significantly improved
quality-of-life scores, reduced dyspnea scores, improved exercise capacity, and
PiMax, but no change in measures of systemic inflammation compared with the
controls. There were no differences in most of the outcome measures between the 2
treatment groups except that subjects who had both acupuncture and PR remained
less breathless for a longer period. The addition of acupuncture to PR did not add
significant benefit in most of the outcomes measured. In addition, this was a small
study with a very short follow-up time of only 3 months.
Postion Statements
None of the following societies feel that acupuncture is supported in peer-reviewed
medical literature for the treatment of COPD:
The American Thoracic Society Documents, (2012), ‘An Official American
Thoracic Society Workshop Report’ on ‘The Integrated Care of the COPD Patient’
does not mention acupuncture as a treatment for COPD.
The Global Initiative for Chronic Obstructive Lung Disease (GOLD, 2013) states
that acupuncture for treatment of COPD has not been adequately tested.
The Work Loss Data Institute (WLDI, 2009) states that acupuncture for
treatment of COPD has not been adequately tested.
The Canadian Thoracic Society (CTS, 2011) does not support the routine use of
acupuncture for patients with COPD due to insufficient evidence.
Although multiple studies have been done to try to determine the efficacy and safety
of acupuncture for the treatment of COPD, and some of the findings were promising,
it has been noted that the majority of studies were small with no long-term
outcomes. Additional larger, peer-reviewed, randomized controlled studies are
necessary to evaluate long-term outcomes in indivuals treated for COPD with
Scientific Rationale – Update October 2012
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Cho et al (2012) investigated the efficacy of acupuncture treatment with
individualized setting for reduction of bothersomeness in participants with chronic
low back pain (cLBP) in a multicenter, randomized, patient-assessor blind, shamcontrolled clinical trial. One hundred thirty adults aged 18-65 with non-specific LBP of
lasting for at least the last 3 months was participated in the three Korean medical
hospitals in Korea. Participants got individualized real acupuncture treatments or
sham acupuncture treatments over 6 weeks (twice a week) from Korean medicine
doctors. Primary outcome was change of Visual Analogue Scale (VAS) score for
bothersomeness of cLBP. Secondary outcomes included VAS for pain intensity and
questionnaires including Oswestry disability index (ODI), General health status (SF36), and Beck's depression inventory (BDI).Results. There were no baseline
differences observed between two groups except ODI. One hundred sixteen
participants finished the treatments and 3-, 6-month follow ups with fourteen
subjects' drop-out. Significant difference of VAS for bothersomeness and pain
intensity of cLBP have been found between two groups (p<0.05) at the primary end
point (8 week). In addition, those two scores have been improved continuously until
3-month follow up (p = 0.011, p = 0.005, respectively). ODI, BDI and SF-36 scores
were also improved in both groups without group difference. Investigators concluded
this randomized sham-controlled trial suggests that acupuncture treatment show the
better effects on the reduction of the bothersomeness and pain intensity than shamcontrol in participants with cLBP.
Bokmand and Flyger (2012) evaluated the effect of acupuncture on hot flashes and
disturbed night sleep in patients treated for breast cancer. The effect of acupuncture
was tested against a sham-acupuncture group and a no-treatment control group.
Plasma estradiol was measured to rule out this as cause of effect. Side effects of the
treatment were registered. 94 women were randomized into the study: 31 had
acupuncture, 29 had sham acupuncture and 34 had no treatment. In the
acupuncture group, 16 patients (52%) experienced a significant effect on hot flashes
compared with seven patients (24%) in the sham group (p < 0.05). The effect came
after the second acupuncture session and lasted for at least 12 weeks after last
treatment. A statistically significant positive effect was seen on sleep in the
acupuncture group compared with the sham-acupuncture and no-treatment groups.
The effect was not correlated with increased levels of plasma estradiol. No side
effects of acupuncture were registered. Investigators concluded that acupuncture
significantly relieves hot flashes and sleep disturbances and is a good and safe
treatment in women treated for breast cancer. The project is registered at Clinical (no: NCT00425776).
Güçel et al (2012) investigated the effect of acupuncture on weight loss and whether
a brief acupuncture treatment of 5 weeks can change circulating levels of leptin,
ghrelin, insulin and cholecystokinin (CCK) in obese women. 40 women with a body
mass index (BMI)>30 kg/m(2) were equally randomised to either an acupuncture
group or a sham (non-penetrating) acupuncture group and received treatment at
LI4, HT7, ST36, ST44 and SP6 bilaterally. Both groups had two sessions of 20
min/week for a total of 10 sessions. Serum insulin, leptin, plasma ghrelin and CCK
levels were measured by ELISA. Acupuncture treatment decreased insulin and leptin
levels and induced weight loss, together with a decrease in BMI compared with sham
acupuncture. Furthermore, between-group analyses demonstrated increases in
plasma ghrelin and CCK levels in subjects who received acupuncture treatment.
Investigators concluded the findings suggest that acupuncture may help to regulate
weight owing to its beneficial effects on hormones such as insulin, leptin, ghrelin and
CCK in obese subjects even after a few weeks of treatment.
Acupuncture Oct 13
Scientific Rationale – Update November 2009
Over the past several decades, the use of complementary and alternative medicine
(CAM) has increased in the general population. Between 1990 and 1997, the
percentage of American patients using alternative therapies grew considerably, from
34 to 42%. Acupuncture is among the CAM therapies most frequently recommended
by internists and family physicians and is currently practiced in over 140 hospitals in
the United States.
Professional Societies
(1997) National Institutes of Health consensus statement concluded that
acupuncture showed promise in adult postoperative and chemotherapy-induced
nausea and vomiting.
(1998) The National Institutes of Health (NIH) Office of Complementary and
Alternative Medicine Consensus Development Statement on acupuncture concluded
that acupuncture is effective in alleviating postoperative and chemotherapy nausea
in adults and may be effective for treating nausea in pregnancy. The NIH Consensus
Statement also concluded that the evidence was promising for the use of
acupuncture in some cases of pain management.
National Comprehensive Cancer Network guidelines recommend nonpharmacological
modalities such as acupuncture if pain scores remain at 4 or above on a 10-point
scale after re-evaluation and modification of pharmacological management. In the
absence of guidelines concerning when and how to incorporate complementary
therapies, decisions should be based on clinical judgment, patient preference, and
the risk/ benefit ratio.
(2003) The U.S. Department of Health and Human Services, Public Health Service,
Agency for Healthcare Research and Quality (AHRQ) recently performed a technology
assessment on Acupuncture for the Treatment of Fibromyalgia; it stated that ‘At this
time, therefore, there is insufficient evidence to conclude that acupuncture has
efficacy for the treatment of fibromyalgia.’
(2007) The American College of Physicians (ACP) and American Pain Society
developed evidence-based clinical practice guidelines for diagnosing and treating low
back pain in the primary care setting. According to the guideline recommendations,
acupuncture is considered a moderately effective nonpharmacologic therapy for
treating chronic low back pain.
(2008) The American Academy of Orthopedic Surgeons has a section on
complementary and alternative therapy, are unable to recommend for or against the
use of acupuncture as an adjunctive therapy for pain relief in patients with
symptomatic OA of the knee. (Level of Evidence: I, Grade of Recommendation:
Chronic Low Back Pain
Deyo et al. (2009) performed a randomized controlled trial called (SPINE)
(Stimulating Points to Investigate Needling Efficacy). 638 adult patients were
included in this study, with patients randomly assigned to 4 groups:
Individualized needle acupuncture, involving a customized prescription for
acupuncture points.
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Standardized needle acupuncture, using single prescription for acupuncture
points on back & backs of legs (i.e. generally effective for chronic LBP)
Simulated acupuncture on same standardized points, mimicking needle
acupuncture but instead of needle using toothpick in needle guide tube w/o
penetrating the skin
Standard medical care pts would have gotten. All pts in 3 acupuncture groups
(individualized, standardized, or simulated) were Rx 2x/wkx3wks, 1x/wkx4wks.
All patients in the three acupuncture groups (individualized, standardized, or
simulated) were treated 2x/weekx3weeks, 1x/weekx4weeks. At 8weeks, 6months,
& 1 year, back-related dysfunction was measured, and patients’ symptoms were
noted. At 8 wks all 3 acupuncture groups were functioning substantially better,
while the group getting only usual care was functioning only slightly better.
Dysfunction scores improved significantly more for all 3 acupuncture groups than for
the usual care group. Benefits lasted for a year, although they waned over time.
Outcomes for groups that received the needle and simulated forms of acupuncture
did not differ significantly. So, although acupuncture effectively treated low back
pain, therapeutic benefit seemed to require neither acupuncture needle sites to
individual patient nor inserting needles into the skin. Simulated acupuncture,
without skin penetration, produced as much benefit as needle acupuncture. The
precise reason why simulated acupuncture relieves low back pain is unknown.
Future research is needed to delve deeper into what is evoking these positive
responses in simulated acupuncture.
Nausea and Vomitting
Since 1997, six studies have demonstrated efficacy for preventing postoperative
nausea and vomiting in children as well. A 2004 Cochrane review of 26 trials
involving 3347 children and adults showed that acupuncture with and without
electrical stimulation and acupressure are effective in decreasing the incidence of
postoperative nausea and vomiting in comparison with controls. When compared,
acupuncture and acupressure are equivalent to antiemetic drugs for preventing
vomiting but are actually better for preventing nausea.
Chronic Pain associated with Osteoarthritis of Knee
Miller et al. (2009) published the results of a randomized controlled clinical trial
(n=55) assessing the efficacy of acupuncture as an adjunct therapy to standard care
in a group of elderly patients with osteoarthritis of the knee. Primary outcome
measures were changes in Knee Society Score (KSS) and in KSS function and pain
ratings at therapy onset, after eight weeks and at 12 weeks. The authors noted
significant improvements in all scores for both groups at eight weeks and 12 weeks
compared with baseline. Acupuncture had a longer lasting effect—significant
differences between the intervention group and control group in the KSS was not
noticeable until after 12 weeks (eight weeks of therapy and one month follow-up).
Berman et al. (2004) completed a randomized controlled trial of 570 patients with
osteoarthritis of knee. Twenty-three true acupuncture sessions were done over 26
weeks. Controls received 6 (2 hour) sessions over 12 weeks or 23 sham acupuncture
sessions in 26 weeks. Patients in the true acupuncture group had >improvement in
WOMAC function scores than the sham acupuncture group at 8 weeks. Acupuncture
seems to provide improvement in function and pain relief as an adjunctive therapy
for osteoarthritis of knee when compared with credible sham acupuncture and
education control.
Acupuncture Oct 13
Migraine Headache
Linde et al. (2009) [Cochrane Database] completed a randomized study with two
reviewers. A post-randomization observation period of at least 8 weeks that
compared the clinical effects of an acupuncture intervention with a control (no
prophylactic treatment or routine care only), a sham acupuncture intervention or
another intervention in patients with migraine. Twenty-two trials with 4419
participants (mean 201, median 42, range 27 to 1715) met the inclusion criteria. Six
trials (including two large trials with 401 and 1715 patients) compared acupuncture
to no prophylactic treatment or routine care only. After 3 to 4 months patients
receiving acupuncture had higher response rates and fewer headaches. The only
study with long-term follow up saw no evidence that effects dissipated up to 9
months after cessation of treatment. Fourteen trials compared a 'true' acupuncture
intervention with a variety of sham interventions. Pooled analyses did not show a
statistically significant superiority for true acupuncture for any outcome in any of the
time windows, but the results of single trials varied considerably. Four trials
compared acupuncture to proven prophylactic drug treatment. Overall in these trials
acupuncture was associated with slightly better outcomes and fewer adverse effects
than prophylactic drug treatment. In the previous version of this review, evidence in
support of acupuncture for migraine prophylaxis was considered promising but
insufficient. Now, with 12 additional trials, there is consistent evidence that
acupuncture provides additional benefit to treatment of acute migraine attacks only
or to routine care. Available studies suggest that acupuncture is at least as effective
as, or possibly more effective than, prophylactic drug treatment, and has fewer
adverse effects. Acupuncture should be considered a treatment option for patients
willing to undergo this treatment.
NOTE: The following are general guidelines that may help to guide the frequency
and duration of acupuncture visits, depending on the severity of the various
conditions that the individual may have:
Stage of Condition
Chronic (Pain/Migraine)
Recurrent (Pain/Migraine)
3x week
3x week
3-5x week
4 weeks
4 weeks
3 weeks
Re-evaluate After
12 Treatments
12 Treatments
15 Treatments
Acupuncture in Lieu of Anesthesia
There are minimal studies done on acupuncture in lieu of anesthesia. Some
acupuncturists are doing this as part of their practice, however, there is no evidencebased peer-reviewed studies to support this practice.
CMS Centers for Medicare & Medicaid
NCD for Acupuncture (30.3)
Until the pending scientific assessment of the technique has been completed and its
efficacy has been established, Medicare reimbursement for acupuncture, as an
anesthetic or as an analgesic or for other therapeutic purposes, may not be made.
Accordingly, acupuncture is not considered reasonable and necessary within the
meaning §1862(a)(1) of the Act.
Fibromyalgia (NCD for Acupuncture for Fibromyalgia (30.3.1)
After careful reconsideration of its initial noncoverage determination for acupuncture,
CMS concludes that there is no convincing evidence for the use of acupuncture for
pain relief in patients with fibromyalgia. Study design flaws presently prohibit
assessing acupuncture’s utility for improving health outcomes.
Acupuncture Oct 13
Osteoarthritis (NCD for Acupuncture for Osteoarthritis (30.3.2)
After careful reconsideration of its initial noncoverage determination for acupuncture,
CMS concludes that there is no convincing evidence for the use of acupuncture for
pain relief in patients with osteoarthritis. Study design flaws presently prohibit
assessing acupuncture’s utility for improving health outcomes.
Scientific Rationale – Initial
Acupuncture is a traditional form of Chinese medical treatment that has been
practiced for over 3000 years. Acupuncture involves piercing the skin with needles at
specific body sites to induce anesthesia, to relieve pain, to alleviate withdrawal
symptoms of substance abusers, or to treat various non-painful disorders (e.g. to
relieve nausea/vomiting). In traditional acupuncture, the placement of needles into
the skin is dictated by the location of meridians. These meridians are thought to
mark patterns of energy flow throughout the human body. The technology has four
components - the acupuncture needle(s), the target location defined by traditional
Chinese medicine, the depth of insertion, and the stimulation of the inserted needle.
The FDA has approved acupuncture needles.
Electroacupuncture (i.e., transcutaneous electrical nerve stimulation (TENS)
acupuncture) is the practice of piercing specific body sites with needles that are
stimulated by an extremely low voltage of electricity.
Review History
October 16, 2003
April 2006
April 2008
September 2009
October 2009
November 2009
March 2011
November 2011
October 2012
October 2013
Medical Advisory Council
Update – no revisions
Update – no revisions. Codes updated.
Policy title changed to Acupuncture
Update. Policy had approved acupuncture for pain.
Added nausea, vomiting, and migraine headaches as
medically necessary. Added Medicare non-coverage.
Codes reviewed.
Revised policy with frequency of visits as advised from
committee members.
Update – no revisions
Update – no revisions
Update – no revisions
Update – Added acupuncture as investigational for
COPD. Codes updated.
Patient Education Websites
1. National Center for Complementary and Alternative Medicine. Acupuncture.
Available at:
1. Fundación de la Artritis. Acupuntura. Acesso en:
This policy is based on the following evidence-based guidelines:
Acupuncture Oct 13
Lee A, Fan LTY. Stimulation of the wrist acupuncture point P6 for preventing
postoperative nausea and vomiting. Cochrane Database of Systematic Reviews,
2009, Issue 2.
2. Linde K, Allais G, Brinkhaus B, et al. Acupuncture for tension-type headache.
Cochrane Database Syst Rev. 2009 Jan 21;(1):CD007587.
3. American Academy of Orthopaedic Sugeons. Treatment of Osteoarthritis of the
knee (non-arthroplasty). Full Guideline. December 6, 2008. Available at:
4. Thomas LH, Cross S, Barrett J, et al. Treatment of urinary incontinence after
stroke in adults. Cochrane Database Syst Rev. 2008;(1): CD004462.
5. Bausewein C, Booth S, Gysels M, et al. Non-pharmacological interventions for
breathlessness in advanced stages of malignant and non-malignant diseases.
Cochrane Database Syst Rev. 2008;(2):CD005623.
6. Xie Y, Wang L, He J, Wu T. Acupuncture for dysphagia in acute stroke. Cochrane
Database Syst Rev. 2008;(3):CD006076.
7. Melchart D, Linde K, Fischer P, et al. Acupuncture for idiopathic headache.
Cochrane Database Systematic Reviews. The Cochrane Library, 2001 Issue 2.
2007. Updated April 15, 2008.
8. Hayes. Search & Summary. Acupuncture for Chronic Obstructive Pulmonary
Disease (COPD). April 23, 2013.
9. Hayes. Health Technology Brief. Acupuncture for Treatment of Chronic
Obstructive Pulmonary Disease (COPD). August 5, 2013.
10. Nici L, ZuWallack R; American Thoracic Society Subcommittee on Integrated
Care of the COPD Patient. An official American Thoracic Society workshop report:
the Integrated Care of The COPD Patient. Proc Am Thorac Soc. 2012;9(1):9-18.
References – Update October 2013
Acupuncture is effective for chronic pain: individual-level meta-analysis. Archives
of Internal Medicine. 2012; 172(19):1-10.
Bo C, Xue Z, Yi G, et al. Assessing the quality of reports about randomized
controlled trials of acupuncture treatment on diabetic peripheral neuropathy.
PLoS One. 2012;7(7):e38461.
Deering BM, Fullen B, Egan C, et al. Acupuncture as an adjunct to pulmonary
rehabilitation. J Cardiopulm Rehabil Prev. 2011 Nov-Dec;31(6):392-9. doi:
Dudgeon D, Shaad J. Assessment and management of dyspnea in palliative
care. UpToDate. July 9, 2013.
Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy
for the diagnosis, management, and prevention of chronic obstructive pulmonary
disease. Vancouver, WA: Global Initiative for Chronic Obstructive Lung Disease;
2013. Summary on National Guideline Clearinghouse. Available at:
He J, Zheng M, Zhang M, Jiang H. Acupuncture for mumps in children. Cochrane
Database Syst Rev. 2012;9:CD008400.
Ma Y, Bu H, Jia JR, Zhang X. Progress of research on acupuncture at trigger
point for myofascial pain syndrome. Zhongguo Zhen Jiu. 2012;32(6):573-576.
Marciniuk DD, Goodridge D, Hernandez P, et al. Canadian Thoracic Society COPD
Committee Dyspnea Expert Working Group. Managing dyspnea in patients with
advanced chronic obstructive pulmonary disease: a Canadian Thoracic Society
clinical practice guideline. Can Respir J. 2011;18(2):69-78. Available at:
Acupuncture Oct 13
National National Center for Complementary and Alternative Medicine (NCCAM).
Acupuncture: An Introduction. Bethesda, MD: National Center for
Complementary and Alternative Medicine; 2011. NCCAM Publication No. D404.
Available at:
Ngai SP, Jones AY, Hui-Chan CW, et al. An adjunct intervention for management
of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). J
Altern Complement Med. 2013 Feb;19(2):178-81. doi: 10.1089/acm.2011.0222.
Epub 2012 Jul 9.
Nici L, ZuWallack R; American Thoracic Society Subcommittee on Integrated
Care of the COPD Patient. An official American Thoracic Society workshop report:
the Integrated Care of The COPD Patient. Proc Am Thorac Soc. 2012;9(1):9-18.
Rakel: Integrative Medicine, 3rd ed. 2012 Saunders, An Imprint of Elsevier.
Evidence for Acupuncture in Headache.
Suzuki M, Muro S, Ando Y, et al. A randomized, placebo-controlled trial of
acupuncture in patients with chronic obstructive pulmonary disease (COPD): the
COPD-acupuncture trial (CAT). Arch Intern Med. 2012;172(11):878-886.
Available at:
Williams HC, Dellavalle RP, Garner S. Acne vulgaris. Lancet.
Wang QP, Bai M, Lei D. Effectiveness of acupuncture in treatment of facial
spasm: A meta-analysis. Altern Ther Health Med. 2012;18(3):45-52.
Yan Z, Ding N, Hua H. A systematic review of acupuncture or acupoint injection
for management of burning mouth syndrome. Quintessence Int.
References – Update October 2012
Bokmand S, Flyger H. Acupuncture relieves menopausal discomfort in breast
cancer patients: A prospective, double blinded, randomized study. Breast. 2012
Aug 17.
Clinical Trials. Gov. The Clinical Efficacy of Acupuncture as an Adjunct to
Methadone Treatment Services for Heroin Addicts. Available at:
Casazza BA. Diagnosis and treatment of acute low back pain. Am Fam
Physician. 2012 Feb 15;85(4):343-50.
Chan SL, Or KH, Sun WZ, et al. Therapeutic effects of acupuncture for
neurogenic dysphagia--a randomized controlled trial. J Tradit Chin Med. 2012
Chang BH, Sommers E. Acupuncture and the relaxation response for treating
gastrointestinal symptoms in HIV patients on highly active antiretroviral therapy.
Acupunct Med. 2011 Sep;29(3):180-7.
Chen YL, Feng WJ, Zhang XL. Parkinson's disease combined with overactive
bladder syndrome treated with acupuncture and medication. Zhongguo Zhen
Jiu. 2012 Mar;32(3):215-8.
Cheuk DK, Yeung WF, Chung KF, Wong V. Acupuncture for insomnia. Cochrane
Database Syst Rev. 2012 Sep 12;9:CD005472.
Cho SY, Shim SR, Rhee HY, et al. Effectiveness of acupuncture and bee venom
acupuncture in idiopathic Parkinson's disease. Parkinsonism Relat Disord. 2012
Cho YJ, Song YK, Cha YY, et al. Acupuncture for Chronic Low Back Pain: A
Multicenter, Randomized, Patient-Assessor Blind, Sham-Controlled Clinical Trial.
Spine (Phila Pa 1976). 2012 Sep 28
Acupuncture Oct 13
10. Chu JM, Bao YH, Zou C, et al. Randomized controlled clinical trials for
electroacupuncture treatment of urinary incontinence in stroke patients. Zhen Ci
Yan Jiu. 2011 Dec;36(6):428-32
11. Chung KF, Yeung WF, Zhang ZJ, et al. Randomized non-invasive shamcontrolled pilot trial of electroacupuncture for postpartum depression. J Affect
Disord. 2012 Jul 25.
12. Cohen M, Parker S, Taylor D, et al. Acupuncture as analgesia for low back pain,
ankle sprain and migraine in emergency departments: study protocol for a
randomized controlled trial. Trials. 2011 Nov 15;12:241.
13. Dong WK, Lin XH. Clinical observation on cervical spondylosis of neck type
treated with acupuncture at original and terminal points of trapezius. Zhongguo
Zhen Jiu. 2012 Mar;32(3):211-4.
14. Gao R, Shi CH, Tian JH, Kang Z. Systematic review of randomized controlled
trials of acupuncture for glaucoma. Zhongguo Zhen Jiu. 2011 Dec;31(12):11425
15. Güçel F, Bahar B, Demirtas C, et al. Influence of acupuncture on leptin, ghrelin,
insulin and cholecystokinin in obese women: a randomised, sham-controlled
preliminary trial. Acupunct Med. 2012 Sep;30(3):203-7
16. Hachul H, Garcia TK, Maciel AL, et al. Acupuncture improves sleep in
postmenopause in a randomized, double-blind, placebo-controlled study.
Climacteric. 2012 Sep 3
17. Hui F, Boyle E, Vayda E, Glazier RH. A randomized controlled trial of a
multifaceted integrated complementary-alternative therapy for chronic herpes
zoster-related pain. Altern Med Rev. 2012 Mar;17(1):57-68
18. Isoyama D, Cordts EB, de Souza van Niewegen AM, et al. Effect of acupuncture
on symptoms of anxiety in women undergoing in vitro fertilisation: a prospective
randomised controlled study. Acupunct Med. 2012 Jun;30(2):85-8.
19. Itoh K, Asai S, Ohyabu H, et al. Effects of trigger point acupuncture treatment
on temporomandibular disorders: a preliminary randomized clinical trial. J
Acupunct Meridian Stud. 2012 Apr;5(2):57-62.
20. Jeon SW, Kim KS, Nam HJ. Long-term effect of acupuncture for treatment of
tinnitus: a randomized, patient- and assessor-blind, sham-acupuncturecontrolled, pilot trial. J Altern Complement Med. 2012 Jul;18(7):693-9.
21. Kim JI, Choi JY, Lee DH, et al. Acupuncture for the treatment of tinnitus: a
systematic review of randomized clinical trials. BMC Complement Altern Med.
2012 Jul 17;12(1):97
22. Kim HM, Cho SY, Park SU, et al. Can Acupuncture Affect the Circadian Rhythm
of Blood Pressure? A Randomized, Double-Blind, Controlled Trial. J Altern
Complement Med. 2012 Aug 20
23. Kong FY, Zhang QY, Guan Q, et al. Effects of electroacupuncture on embryo
implanted potential for patients with infertility of different symptom complex.
Zhongguo Zhen Jiu. 2012 Feb;32(2):113-6
24. Lee JA, Park SW, Hwang PW, et al. Acupuncture for shoulder pain after stroke:
a systematic review. J Altern Complement Med. 2012 Sep;18(9):818-23.
25. Liang ZH, Di Z, Jiang S, et al. The optimized acupuncture treatment for neck
pain caused by cervical spondylosis: a study protocol of a multicentre
randomized controlled trial. Trials. 2012 Jul 9;13:107.
26. Lin JG, Chan YY, Chen YH. Acupuncture for the treatment of opiate addiction.
Evid Based Complement Alternat Med. 2012;2012:739045.
27. Liu W, Yang G, Zhao XJ, et al. Impact of acupuncture on 24 h intraocular
pressure of glaucoma. Zhongguo Zhen Jiu. 2011 Jun;31(6):518-20
28. Liu YQ, Ma LX, Xing JM,et al. Does Traditional Chinese Medicine Pattern Affect
Acupoint Specific Effect? Analysis of Data from a Multicenter, Randomized,
Acupuncture Oct 13
Controlled Trial for Primary Dysmenorrhea. J Altern Complement Med. 2012 Jul
Manheimer E, Cheng K, Wieland LS, et al. Acupuncture for treatment of irritable
bowel syndrome. Cochrane Database Syst Rev. 2012 May 16;5:CD005111.
Long YB, Wu XP. A meta-analysis of the efficacy of acupuncture in treating
dysphagia in patients with a stroke. Acupunct Med. 2012 Sep 22
Mao JJ, Leed R, Bowman MA, et al. Acupuncture for hot flashes: decision
making by breast cancer survivors. J Am Board Fam Med. 2012 MayJun;25(3):323-32.
Meng Z, Kay Garcia M, Hu C, et al. Sham-controlled, randomised, feasibility trial
of acupuncture for prevention of radiation-induced xerostomia among patients
with nasopharyngeal carcinoma. Eur J Cancer. 2012 Jul;48(11):1692-9
Meng Z, Garcia MK, Hu C, et al. Randomized controlled trial of acupuncture for
prevention of radiation-induced xerostomia among patients with nasopharyngeal
carcinoma. Cancer. 2012 Jul 1;118(13):3337-44
Mischoulon D, Brill CD, Ameral VE, et al. A pilot study of acupuncture
monotherapy in patients with major depressive disorder. J Affect Disord. 2012
Apr 20.
Otte JL, Carpenter JS, Zhong X, Johnstone PA. Feasibility study of acupuncture
for reducing sleep disturbances and hot flashes in postmenopausal breast cancer
survivors. Clin Nurse Spec. 2011 Sep-Oct;25(5):228-36.
Scheewe S, Vogt L, Minakawa S, et al. Acupuncture in children and adolescents
with bronchial asthma: a randomised controlled study. Complement Ther Med.
2011 Oct;19(5):239-46
Shiflett SC, Schwartz GE. Effects of acupuncture in reducing attrition and
mortality in HIV-infected men with peripheral neuropathy. Explore (NY). 2011
Shin JS, Ha IH, Lee TG, et al. Motion style acupuncture treatment (MSAT) for
acute low back pain with severe disability: a multicenter, randomized, controlled
trial protocol. BMC Complement Altern Med. 2011 Dec 13;11:127.
Smith CA, de Lacey S, Chapman M, et al. Acupuncture to improve live birth
rates for women undergoing in vitro fertilization: a protocol for a randomized
controlled trial. Trials. 2012 May 18;13:60.
Snyder J, Brown P. Complementary and alternative medicine in children: an
analysis of the recent literature. Curr Opin Pediatr. 2012 Aug;24(4):539-46.
Song XG, Lü H, Cai XH, Zhang RJ. Survey of studies on drug abstinence with
acupuncture in recent 10 years. Zhongguo Zhen Jiu. 2012 Jul;32(7):669-72.
Sui Y, Zhao HL, Wong VC, et al. A systematic review on use of Chinese medicine
and acupuncture for treatment of obesity. Obes Rev. 2012 May;13(5):409-30
Tobbackx Y, Meeus M, Wauters L, et al. Does acupuncture activate endogenous
analgesia in chronic whiplash-associated disorders? A randomized crossover trial.
Eur J Pain. 2012 Sep 11. doi: 10.1002/j.1532-2149.2012.00215.x.
Tu JH, Chung WC, Yang CY, Tzeng DS. A comparison between acupuncture
versus zolpidem in the treatment of primary insomnia. Asian J Psychiatr. 2012
Yao E, Gerritz PK, Henricson E, et al. Randomized controlled trial comparing
acupuncture with placebo acupuncture for the treatment of carpal tunnel
syndrome. PM R. 2012 May;4(5):367-73.
Vas J, Aranda JM, Modesto M, et al. Acupuncture in patients with acute low back
pain: A multicentre randomised controlled clinical trial. Pain. 2012
Ward U, Nilsson UG. Acupuncture for Postoperative Pain in Day Surgery Patients
Undergoing Arthroscopic Shoulder Surgery. Clin Nurs Res. 2012 Jul 27.
Acupuncture Oct 13
48. Wechsler ME, Kelley JM, Boyd IO, et al. Active albuterol or placebo, sham
acupuncture, or no intervention in asthma. N Engl J Med. 2011 Jul
49. Wu JP, Gu SZ. Randomized controlled trials for treatment of 30 cases of
ordinary psoriasis by acupuncture and moxibustion. Zhen Ci Yan Jiu. 2011
50. Wu J, Yeung AS, Schnyer R, et al. Acupuncture for depression: a review of
clinical applications. Can J Psychiatry. 2012 Jul;57(7):397-405.
51. Yang YQ, Chen HP, Wang Y, et al. Considerations for Use of Acupuncture as
Supplemental Therapy for Patients with Allergic Asthma. Clin Rev Allergy
Immunol. 2012 Jun 3.
52. Zhang J, Li X, Xu J, Ernst E. Laser acupuncture for the treatment of asthma in
children: a systematic review of randomized controlled trials. J Asthma. 2012
53. Zhuang L, Yang Z, Zeng X, et al. The Preventive and Therapeutic Effect of
Acupuncture for Radiation-Induced Xerostomia in Patients With Head and Neck
Cancer: A Systematic Review. Integr Cancer Ther. 2012 Jul 16
54. Wong RK, James JL, Sagar S, et al. Phase 2 results from Radiation Therapy
Oncology Group Study 0537: A phase 2/3 study comparing acupuncture-like
transcutaneous electrical nerve stimulation versus pilocarpine in treating early
radiation-induced xerostomia. Cancer. 2012 Sep 1;118(17):4244-52.
References – Update November 2011
Aranha MF, Alves MC, Bérzin F, Gavião MB. Efficacy of electroacupuncture for
myofascial pain in the upper trapezius muscle: a case series. Rev Bras Fisioter.
2011 Oct 14. pii: S1413-35552011005000022.
2. Cameron ID, Wang E, Sindhusake D. A Randomized Trial Comparing
Acupuncture and Simulated Acupuncture, for Sub-acute and Chronic Whiplash.
Spine (Phila Pa 1976). 2011 Apr 7.
3. Chen M, Shi XY, Xu B, et al. Clinical observation on acupotomy for treatment of
simple obesity. Zhongguo Zhen Jiu. 2011 Jun;31(6):539-42
4. Huang DM, Huang GY, Lu FE, et al. Acupuncture for infertility: is it an effective
therapy? Chin J Integr Med. 2011 May;17(5):386-95
5. Johansson K, Bergström A, Schröder K, Foldevi M. Subacromial corticosteroid
injection or acupuncture with home exercises when treating patients with
subacromial impingement in primary care--a randomized clinical trial. Fam
Pract. 2011 Aug;28(4):355-65
6. Kim DI, Jeong JC, Kim KH, et al. Acupuncture for hot flushes in perimenopausal
and postmenopausal women: a randomised, sham-controlled trial. Acupunct
Med. 2011 Jun 8
7. Kumnerddee W, Kaewtong A. Efficacy of acupuncture versus night splinting for
carpal tunnel syndrome: a randomized clinical trial. J Med Assoc Thai. 2010
8. Liu W, Yang G, Zhao XJ, et al. Impact of acupuncture on 24 h intraocular
pressure of glaucoma. Zhongguo Zhen Jiu. 2011 Jun;31(6):518-20
9. Mackenzie IZ, Xu J, Cusick C, Midwinter-Morten H, et al. Acupuncture for pain
relief during induced labour in nulliparae: a randomised controlled study. BJOG.
2011 Mar;118(4):440-7. doi: 10.1111/j.1471-0528.2010.02825.x
10. O'Sullivan EM, Higginson IJ. Clinical effectiveness and safety of acupuncture in
the treatment of irradiation-induced xerostomia in patients with head and neck
cancer: a systematic review. Acupunct Med. 2010 Dec;28(4):191-9
Acupuncture Oct 13
11. Shi ZM, Zhu YS, Wang QX, Lei MN. Comparative study on irritable bowel
syndrome treated with acupuncture and western medicine. Zhongguo Zhen Jiu.
2011 Jul;31(7):607-9
12. Sim H, Shin BC, Lee MS, et al. Acupuncture for carpal tunnel syndrome: a
systematic review of randomized controlled trials. Pain. 2011 Mar;12(3):30714.
13. Smith CA, Collins CT, Crowther CA, Levett KM. Acupuncture or acupressure for
pain management in labour. Cochrane Database Syst Rev. 2011 Jul
14. Smith CA, Crowther CA, Petrucco O, et al. Acupuncture to treat primary
dysmenorrhea in women: a randomized controlled trial. Evid Based Complement
Alternat Med. 2011;2011:612464
15. Smith CA, Ussher JM, Perz J, et al. The Effect of Acupuncture on Psychosocial
Outcomes for Women Experiencing Infertility: A Pilot Randomized Controlled
Trial. J. Altern Complement Med. 2011 Oct 6
16. Su JT, Zhou QH, Li R, et al. Immediate analgesic effect of wrist-ankle
acupuncture for acute lumbago: a randomized controlled trial. Zhongguo Zhen
Jiu. 2010 Aug;30(8):617-22
17. Sun MY, Hsieh CL, Cheng YY, et al. The therapeutic effects of acupuncture on
patients with chronic neck myofascial pain syndrome: a single-blind randomized
controlled trial. Am J Chin Med. 2010;38(5):849-59.
18. Takayama S, Seki T, Nakazawa T, et al. Short-term effects of acupuncture on
open-angle glaucoma in retrobulbar circulation: additional therapy to standard
medication. Evid Based Complement Alternat Med. 2011;2011:157090
19. Tong J, Chen JX, Zhang ZQ, et al. Clinical observation on simple obesity treated
by acupuncture. Zhongguo Zhen Jiu. 2011 Aug;31(8):697-701
20. Ursini T, Tontodonati M, Manzoli L, et al. Acupuncture for the treatment of
severe acute pain in herpes zoster: results of a nested, open-label, randomized
trial in the VZV Pain Study. BMC Complement Altern Med. 2011 Jun 5;11:46
21. White AR, Rampes H, Liu JP, et al. Acupuncture and related interventions for
smoking cessation. Cochrane Database Syst Rev. 2011 Jan 19;(1):CD000009
22. Wu F, Kang MF, Xiong P, Xiong J. Clinical randomized controlled trials of
treatment of neck-back myofascial pain syndrome by acupuncture of Ashi-points
combined with moxibustion of heat-sensitive points. Zhen Ci Yan Jiu. 2011
23. Yang CP, Wang NH, Li TC, et al. A randomized clinical trial of acupuncture
versus oral steroids for carpal tunnel syndrome: a long-term follow-up. Pain.
2011 Feb;12(2):272-9
24. Zhu X, Hamilton KD, McNicol ED. Acupuncture for pain in endometriosis.
Cochrane Database Syst Rev. 2011 Sep 7;9:CD007864
References – Updated March 2011
Coura LE, Manoel CH, Poffo R, et al. Randomised, controlled study of
preoperative eletroacupuncture for postoperative pain control after cardiac
surgery. Acupunct Med. 2011 Mar;29(1):16-20
Jung A, Shin BC, Lee MS, Sim H, Ernst E. Acupuncture for treating
temporomandibular joint disorders: A systematic review and meta-analysis of
randomized, sham-controlled trials. J Dent. 2011 Feb 25. [
Kumnerddee W, Kaewtong A. Efficacy of acupuncture versus night splinting for
carpal tunnel syndrome: a randomized clinical trial. J Med Assoc Thai. 2010
Dec;93(12): 1463-9.
Acupuncture Oct 13
Lee MS, Ernst E. Acupuncture for pain: An overview of Cochrane reviews. Chin
J Integr Med. 2011 Mar;17(3):187-9.
Lee SW, Liong ML, Yuen KH, et al. Validation of a sham acupuncture procedure
in a randomised, controlled clinical trial of chronic pelvic pain treatment.
Acupunct Med. 2011 Mar;29(1):40-6.
Liang Z, Zhu X, Yang X, Fu W, Lu A. Assessment of a traditional acupuncture
therapy for chronic neck pain: a pilot randomised controlled study.
Li HJ, Zhong BL, Fan YP, Hu HT. Acupuncture for post-stroke depression: a
randomized controlled trial. Zhongguo Zhen Jiu. 2011 Jan;31(1):3-6
Lin CW, Haas M, Maher CG, et al. Cost-effectiveness of guideline-endorsed
treatments for low back pain: a systematic review. Eur Spine J. 2011 Jan 13
Paley CA, Johnson MI, Tashani OA, Bagnall AM. Acupuncture for cancer pain in
adults. Cochrane Database Syst Rev. 2011 Jan 19;(1):CD007753.
Smith CA, Zhu X, He L, Song J. Acupuncture for primary dysmenorrhoea.
Cochrane Database Syst Rev. 2011 Jan 19;(1):CD007854
Sunay D, Ozdiken M, Arslan H, et al. The effect of acupuncture on
postmenopausal symptoms and reproductive hormones: a sham controlled
clinical trial. Acupunct Med. 2011 Mar;29(1):27-31.
Yang CP, Wang NH, Li TC, et al. A randomized clinical trial of acupuncture
versus oral steroids for carpal tunnel syndrome: a long-term follow-up. J Pain.
2011 Feb;12(2):272-9.
Yeh ML, Chung YC, Chen KM, et al. Acupoint electrical stimulation reduces acute
postoperative pain in surgical patients with patient-controlled analgesia: a
randomized controlled study. Altern Ther Health Med. 2010 Nov-Dec;16(6):108.
References – Updated October 2009
Deyo RA, Khalsa PS, Avins AL, et al. Acupuncture eases chronic low back pain in
SPINE trial. Stimulating Points to Investigate Needling Efficacy, (SPINE). The
National Center for Complementary and Alternative Medicine (NCCAM), part of
the National Institutes of Health, funded the SPINE trial. 2009.
2. Miller E, Maimon Y, Rosenblatt Y, et al. Delayed Effect of Acupuncture Treatment
in OA of the Knee: A Blinded, Randomized, Controlled Trial. Evid Based
Complement Alternat Med. 2009 Jan 5.
3. Smith CA, Crowther CA, Collins CT, et al. Acupuncture to induce labor: A
randomized controlled trial. Obstet Gynecol. 2008;112(5):1067-1074.
4. Cheong YC, Hung Yu Ng E, et al. Acupuncture and assisted conception. Cochrane
Database Syst Rev. 2008;(4):CD006920.
5. El-Toukhy T, Sunkara SK, Khairy M, et al. A systematic review and metaanalysis of acupuncture in in vitro fertilisation. BJOG. 2008;115(10):1203-1213.
6. Ng EH, So WS, Gao J, et al. The role of acupuncture in the management of
subfertility. Fertil Steril. 2008;90(1):1-13.
7. Lam YC, Kum WF, Durairajan SS, et al. Efficacy and safety of acupuncture for
idiopathic Parkinson's disease: A systematic review. J Altern Complement Med.
8. Ben-Aharon I, Gafter-Gvili A, Paul M, et al. Interventions for alleviating cancerrelated dyspnea: A systematic review. J Clin Oncol. 2008;26(14):2396-2404.
9. Lee MS, Pittler MH, Shin BC, et al. Bee venom acupuncture for musculoskeletal
pain: A review. J Pain. 2008;9(4):289-297.
10. Roberts J, Huissoon A, Dretzke J, et al. A systematic review of the clinical
effectiveness of acupuncture for allergic rhinitis. BMC Complement Altern Med.
Acupuncture Oct 13
11. Facco E, Liguori A, Petti F, et al. Traditional acupuncture in migraine: A
controlled, randomized study. Headache. 2008;48(3):398-407
12. Alecrim-Andrade J, Maciel-Júnior JA, Carnè X, et al. Acupuncture in Migraine
Prevention: A Randomized Sham Controlled Study With 6-months Posttreatment
Follow-up. Clin J Pain. 2008 Feb;24(2):98-105.
13. Yuan J, Purepong N, Kerr DP, Park J, et al. Effectiveness of acupuncture for low
back pain: a systematic review. Spine. 2008 Nov 1;33(23):E887-900.
14. Sun Y, Gan TJ. Acupuncture for the management of chronic headache: a
systematic review. Anesth Analg. 2008 Dec;107(6):2038-47.
15. Selfe TK, Taylor AG. Acupuncture and osteoarthritis of the knee: a review of
randomized, controlled trials. Fam Community Health. 2008 Jul-Sep;31(3):24754.
16. Jubb RW, Tukmachi ES, Jones PW, et al. A blinded randomised trial of
acupuncture (manual and electroacupuncture) compared with a non-penetrating
sham for the symptoms of osteoarthritis of the knee. Acupunct Med. 2008
17. Hurwitz EL, Carragee EJ, van der V, et al. Bone and Joint Decade 2000-2010
Task Force on Neck Pain and Its Associated Disorders. Treatment of neck pain:
noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task
Force on Neck Pain and Its Associated Disorders. Spine. 2008 Feb 15;33(4
18. Michelfelder AJ. Acupuncture for Headaches and Acupuncture for Nausea and
Vomiting. Rakel: Integrative Medicine, 2nd ed. 2007 Saunders, An Imprint of
19. Berman BM, Lao L, Lange P, et al. Effectiveness of Acupuncture as Adjunctive
Therapy in Osteoarthritis of the Knee. A Randomized, Controlled Trial. Annals of
Internal Medicine. 21 December 2004 | Volume 141 Issue 12 | Pages 901-910.
20. Centers for Medicare & Medicaid Services (CMS). NCD for Acupuncture for
Fibromyalgia (30.3.1) Pub. 100-03. Effective 2004 Apr 16. Available at:
21. Centers for Medicare & Medicaid Services (CMS). Acupuncture for Osteoarthritis
National coverage determination (NCD) (30.3.2). Effective 2004 April 16.
Available at:
22. Centers for Medicare & Medicaid Services (CMS). NCD for Acupuncture (30.3).
Available at:
References – Updated April 2008
Lee SWH, Liong ML, Yuen KH, et al. Acupuncture versus Sham Acupuncture for
Chronic Prostatis/Chronic Pelvic Pain. The American Journal of Medicine. Volume
121, Issue I (January 2008)
EE CE, Manheimer E, Pirotta MV, et al. Acupuncture for Pelvic Pain and Back
MARCH 2008.
Cherkin DC, Sherman KJ, Hogeboom CJ, et al. Efficacy of acupuncture for
chronic low back pain: protocol for a randomized controlled trial. PubMed
2008 Feb 28;9(1):10.
Acupuncture Oct 13
Tam LS, Leung PC, Li TK, Zhang L, et al. Acupuncture in the treatment of
rheumatoid arthritis: a double blind controlled pilot study. BMC Complement
Altern Med. 2007 Nov 3;7:35.
Brinkhaus B, Witt CM, Jena S, et al. Physician and treatment characteristics in a
randomised multicentre trial of acupuncture in patients with osteoarthritis of the
knee. Complement Ther Med. 2007 Sep;15(3):180-9. Epub 2006 Jun 22.
Cassileth BR, Deng GE, Gomez JE, et al. Complementary therapies and
integrative oncology in lung cancer: ACCP evidence-based clinical practice
guidelines (2nd edition). Chest. 2007 Sep;132(3 Suppl):340S-354S.
References - Initial
1. Audette JF, Blinder RA. Curr Pain Headache Rep. 2003 Oct;7(5):395-401.
2. Berman BM, Swyers JP, Ezzo J. The Evidence for Acupuncture as a Treatment for
Rheumatologic Conditions. Rheumatic Disease Clinics of North America 2000 Feb;
26(1): 103-15.
3. Chen R, Nickel JC. Acupuncture ameliorates symptoms in men with chronic
prostatitis/chronic pelvic pain syndrome. Urology. 2003 Jun;61(6):1156-9
4. Cummings M. Referred knee pain treated with electroacupuncture to iliopsoas.
Acupunct Med. 2003 Jun;21(1-2):32-5.
5. Guerra J, Bassas E, Andres M, et al. Acupuncture for soft tissue shoulder
disorders: a series of 201 cases. Acupunct Med. 2003 Jun;21(1-2):18-22;
discussion 22
6. Meng CF, Wang D, Ngeow J, et al. Acupuncture for chronic low back pain in older
patients: a randomized, controlled trial. Rheumatology (Oxford). 2003 Jul 30
7. Rabinstein AA, Shulman LM. Acupuncture in clinical neurology. Neurolog. 2003
8. Sator-Katzenschlager SM, Szeles JC, Scharbert G, et al. Electrical stimulation of
auricular acupuncture points is more effective than conventional manual auricular
acupuncture in chronic cervical pain: a pilot study. Anesth Analg. 2003
9. Smith MJ, Tong HC, Werner RA, Haig AJ. Acupuncture analgesia and
electromyography. Arch Phys Med Rehabil. 2003 Sep;84(9):E1-2.
10. Usichenko TI, Ivashkivsky OI, Gizhko VV. Treatment of rheumatoid arthritis with
electromagnetic millimeter waves applied to acupuncture points--a randomized
double blind clinical study. Acupunct Electrother Res. 2003;28(1-2):11-8.
11. Yeung CK, Leung MC, Chow DH. The use of electro-acupuncture in conjunction
with exercise for the treatment of chronic low-back pain. J Altern Complement
Med. 2003 Aug;9(4):479-90.
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discrepancy between the Policies and the Member’s contract, the Member’s contract shall govern.
Policy Limitation: Legal and Regulatory Mandates and Requirements.
The determinations of coverage for a particular procedure, drug, service or supply is subject to applicable
legal and regulatory mandates and requirements. If there is a discrepancy between the Policies and legal
mandates and regulatory requirements, the requirements of law and regulation shall govern.
Policy Limitations: Medicare and Medicaid.
Policies specifically developed to assist Health Net in administering Medicare or Medicaid plan benefits and
determining coverage for a particular procedure, drug, service or supply for Medicare or Medicaid
members shall not be construed to apply to any other Health Net plans and members. The Policies shall
not be interpreted to limit the benefits afforded Medicare and Medicaid members by law and regulation.
Acupuncture Oct 13