Cigna Complementary & Alternative Medicine Policy Update | OpenPayer
CurrentCignaPolicy EN0086
Complementary and Alternative Medicine
Defines Cigna's coverage stance for a wide range of complementary and alternative medicine diagnostic tests, systems, therapies, and treatments and guidance for providers on coverage determinations under member benefit plans.
Policy Summary
PayerCigna
PolicyComplementary and Alternative Medicine
Policy CodePolicy EN0086
Change TypeOperational updates (examples removed); no material clinical changes
Effective DateFeb 15, 2026
Next Review DateFeb 15, 2027
Key ActionRefer to the customer's benefit plan document for coverage details and obtain prior authorization when required by the member's plan.
No clinical policy statement changes noted for annual reviews on 2/15/2026, 2/15/2024 and focused review on 11/15/2024.
~100+distinct CAM items listed
multiplesystematic reviews cited
insufficient evidencemodalities with insufficient evidence
wilderness therapyinvestigational stance examples
EN0086Coverage Policy Number
2026-02-15Effective
Coverage Criteria — Complementary and Alternative Medicine (CAM)
inv-01: General Experimental/Investigational/Unproven Stance
Each of the following complementary or alternative medicine diagnostic testing methods, systems, therapies, or treatments is considered experimental, investigational, or unproven:
Overall stance: The listed CAM diagnostic tests, therapies, and treatments are considered experimental, investigational, or unproven and therefore not established treatment options.
See lists of specific items by therapeutic input in policy
inv-02: Approaches lacking sufficient evidence
Specific CAM approaches described in the policy lack sufficient high-quality evidence for accuracy, safety, or clinical utility:
Diagnostic testing methods: Antioxidant function testing (e.g., Spectrox), nutrient/micronutrient panel testing, applied kinesiology, chemical hair analysis, Greek cancer cure test, iridology, live blood cell analysis, and Ream's testing lack sufficient high-quality evidence to establish accuracy or clinical utility.
See policy descriptions and citations.
Nutritional approaches: Auto urine therapy, Kelley–Gonzales (Gonzalez) therapy, macrobiotics, megavitamin therapy, and listed over-the-counter biologics are described as lacking evidence of safety or effectiveness.
Examples and lists provided in policy.
Psychological approaches: Color therapy, faith healing, guided (interactive) imagery, humor therapy, hypnosis, mirror box therapy, and meditation/Transcendental Meditation (TM) are described as having insufficient high-quality evidence to support clinical utility for the reviewed indications.
Systematic reviews and meta-analyses cited where available.
Physical/manual approaches: Acupressure, Alexander technique, AMMA Therapy, BELD, craniosacral therapy, cupping, ear candling, Hellerwork, inversion therapy, myotherapy, Pfrimmer Deep Muscle Therapy, Pilates, remedial massage, reflexology, Rolfing, therapeutic touch, Trager, and Tui Na are described as lacking sufficient high-quality evidence to support clinical utility.
Policy lists these physical modalities as experimental/investigational/unproven.
inv-03: Coverage summary — evidence-based stance
Summary statements in this excerpt:
Insufficient evidence statements: For multiple therapies (color therapy, faith healing, interactive guided imagery, humor therapy, hypnosis, mirror box therapy for many indications, primal therapy, psychodrama, acupressure), the document states there is 'insufficient high-quality evidence in the published, peer-reviewed, scientific literature to support the clinical utility'.
Repeated phrasing across modality sections.
Therapies with some positive but limited evidence: Some modalities (e.g., mirror therapy, meditation/TM, auricular acupressure) show signals of benefit in small or low-to-moderate quality trials or meta-analyses, but authors emphasize heterogeneity, small samples, risk of bias, and need for larger, higher-quality RCTs.
See cited systematic reviews and meta-analyses.
inv-04: Modality-level evidence summaries
Summaries of systematic reviews and meta-analyses for each modality — report of efficacy, quality, and limitations.
Lee et al. 2025; 6 RCTs; immediate outcomes; adverse events minimal
Acupressure - labor pain: Moderate-to-low certainty: pooled RCTs showed reductions in labor pain versus touch/sham/no intervention but GRADE and possible publication bias limit certainty; more high-quality trials needed.
Larki et al. 2025; 37 RCTs
Acupressure - insomnia in breast cancer: Some trials show improved sleep quality and QOL with auricular acupressure versus controls; evidence limited by small samples, short follow-up, and heterogeneity.
Huang et al. 2025; 15 RCTs
inv-05: Overall coverage considerations
Summary stance based on reviewed evidence
General evidence-based coverage logic
Therapies with some positive but low-quality evidence: Cupping, Tuina, reflexology, and similar therapies have some trials showing benefit for certain conditions (e.g., pain, insomnia, diabetic peripheral neuropathy, labor outcomes), but the evidence is frequently low quality and inconsistent.
See condition-specific systematic reviews.
Therapies with safety concerns or contraindications: Ear candling is ineffective and can cause burns; inversion therapy has multiple contraindications; wet cupping has reported adverse events including fainting, skin laceration, and circulatory instability.
Safety concerns noted in policy sections.
inv-06: Coverage with insufficient evidence
General coverage stance for the modalities summarized in this section
Insufficient evidence statement: For each listed modality (e.g., visceral massage, art therapy, dance movement therapy, hippotherapy, music therapy, pet therapy, qigong), there is currently insufficient high-quality evidence in the published, peer-reviewed literature to support clinical utility.
Statement repeated across respective modality subsections.
inv-07: Evidence summaries (meta-analyses and systematic reviews)
Findings from selected systematic reviews and meta-analyses (evidence summaries)
Art therapy evidence summaries: Systematic reviews report possible benefits for anxiety and depression in some populations, but findings are limited by heterogeneity, small sample sizes, and methodological weaknesses; some meta-analyses show statistically significant effects but with high heterogeneity.
Mizera et al. (2025), Zhou et al. (2025), Joschko et al. (2024), Maddox et al. (2024)
Hippotherapy evidence summaries: Systematic reviews report statistically significant improvements for some motor and functional outcomes in neuromotor disabilities, but limitations include small samples, heterogeneity, and limited long-term data.
Stergiou et al. (2025), Giannou et al. (2024)
Qigong evidence summary: Systematic reviews for cervical spondylosis, frailty, and low back pain report reductions in pain and improvements in function, but heterogeneity, short follow-up, and low methodological quality limit definitive conclusions.
Liu et al. (2025a), Sun et al. (2025b), Yu et al. (2025)
inv-08: Coverage stance by modality
Summary coverage stance and rationale based on evidence presented
Qigong has been studied for multiple conditions with some positive outcomes reported, but trials are small, heterogeneous, and short-term; overall evidence is insufficient to support broad clinical utility.
See systematic reviews and meta-analyses cited.
Recreational Therapy: There is a lack of evidence investigating clinical efficacy; insufficient high-quality evidence to support clinical utility.
Policy statement on recreational therapy.
Wilderness/Adventure Therapy: Evidence consists mainly of small case series and heterogeneous studies with inconsistent outcomes; not demonstrated to be safe and effective and considered experimental/investigational/unproven.
Policy conclusion on wilderness therapy.
Yoga:
inv-09: Coverage stance summary
Overall conclusions in the document regarding clinical utility and evidence sufficiency
General sufficiency: For most complementary and alternative therapies described, there is insufficient high-quality evidence in the published, peer-reviewed literature to support clinical utility.
Multiple chunks summarize this conclusion and study limitations.
Exceptions and emerging evidence: Some individual trials or meta-analyses (e.g., intradiscal ozone therapy showing VAS/ODI improvements; select homeopathy RCTs) report positive findings, but results are inconsistent, heterogeneous, and limited by study quality and short follow-up, and do not establish consistent clinical benefit.
LlombartBlanco et al., Kumar et al., Prosberg et al.
inv-10: Coverage evidence summary
Evidence-based coverage considerations summarized from systematic reviews and RCTs
Ozone therapy evidence: Systematic reviews and meta-analyses report some short-term improvements in pain and function for intradiscal and paravertebral ozone therapy for lumbar disc disease, but heterogeneity, variable study quality, inconsistent adverse event reporting, and short follow-up limit confidence in sustained clinical benefit.
Ozone therapy for other conditions: For chronic wounds and knee osteoarthritis, RCTs/meta-analyses do not provide conclusive evidence of superiority of ozone versus standard treatments.
Fitzpatrick 2018; Li 2018; Liu 2015
Trichuris suis ova therapy: Multiple RCTs and a recent randomized trial show no consistent clinical benefit for ulcerative colitis or Crohn disease; some transient symptom effects observed but not sustained.
Prosberg 2024; Huang 2018; Summers 2005
inv-11: Evidence summary and implication for coverage
Summary of coverage-relevant evidence across conditions
General evidence quality: For most CAM modalities and conditions reviewed, evidence is insufficient, inconsistent, or of low-to-very-low quality due to small sample sizes, short follow-up, heterogeneity, and methodological limitations.
Supports restrictive or case-by-case coverage decisions.
Condition-specific positive signals: Some trials and reviews reported small or short-term benefits for specific modalities and conditions (e.g., guided imagery/hypnosis for fibromyalgia end-of-therapy pain reduction; tai chi, relaxation, music for sleep; acupuncture and self-hypnosis reducing need for pharmacologic pain relief in labor), but overall quality was low and conclusions limited.
May justify investigational or adjunctive use in select circumstances.
Guideline-supported uses: Several professional organizations provide conditional or limited recommendations for specific mind-body modalities (e.g., yoga, acupressure, hypnosis, music therapy) for defined indications; where guideline-supported, use should align with specified indications and quality expectations.
inv-12: Examples of covered with criteria (guideline-based)
Guideline-based coverage stance varies by condition and intervention; examples from NCCN and SIO/ASCO show specific interventions are recommended in particular contexts.
NCCN - Cancer-related fatigue: Yoga and massage therapy are recommended for patients on active cancer treatment (Category 1); yoga is recommended post-treatment (Category 1).
NCCN 2025c recommendations.
NCCN - Antiemesis: Hypnosis, relaxation exercises including guided imagery, music therapy, and yoga are appropriate for anticipatory emesis prevention/treatment (Category 2A).
NCCN 2025b recommendations.
SIO/ASCO - Anxiety/Depression in cancer: Yoga, hypnosis, music therapy, reflexology, and tai chi/qigong may be offered in specified contexts (e.g., stronger evidence in breast cancer); many recommendations are low-to-intermediate quality and conditional.
SIO/ASCO guideline summaries.
inv-13: Not supported / Insufficient evidence
Interventions lacking sufficient evidence or advised against in guidelines.
Insufficient or inconclusive evidence: Acupuncture, bright light therapy, ginseng, massage (in some perioperative contexts), mistletoe, omega fatty acids, many herbal products, psilocybin, and other listed interventions have insufficient or inconclusive evidence to recommend for or against use.
ASCO/SIO and SIO/ASCO guideline statements.
VA/DoD - Insufficient or suggested against: VA/DoD suggests against certain supplements for insomnia (e.g., chamomile, melatonin) and reports insufficient evidence for yoga/meditation for insomnia; other interventions are similarly rated as insufficient.
VA/DoD guideline excerpts.
NICE - Not to offer during labour: NICE advises not to offer acupuncture, acupressure, or hypnosis during labour (unless a woman chooses and wishes support).
NICE guidance cited in policy.
Coverage for complementary and alternative medicine (CAM) tests and therapies varies by member benefit plan. Providers must refer to the customer's specific benefit plan document (for example, Group Service Agreement, Evidence of Coverage, Certificate of Coverage, or Summary Plan Description) to determine whether a requested service is covered and whether prior authorization is required. In the event of a conflict, the member's benefit plan document supersedes this Coverage Policy, and claims for services not billed with covered diagnosis or procedure codes listed in the applicable Coverage Policy may be denied as not covered.
The document repeatedly states that a range of specific CAM therapies have insufficient high‑quality evidence in the peer‑reviewed literature to support clinical utility. Examples called out in the policy (not exhaustive) include diagnostic tests (e.g., chemical hair analysis, iridology, live blood cell analysis), nutritional approaches (e.g., megavitamin therapy, over‑the‑counter biologics), psychological techniques (e.g., color therapy, faith healing, guided imagery, hypnosis), and many physical and combination interventions; these listings indicate lack of established clinical benefit absent stronger, high‑quality evidence.
Bio Photonic Lymphatic Drainage Treatment (BELD) is described as a proprietary, device‑based intervention claiming lymphatic ‘‘decongestion’’ and other benefits. The policy notes there is a lack of published, peer‑reviewed evidence
Ear candling (ear coning) involves inserting a hollow, lit candle into the ear canal and is purported to remove cerumen by a vacuum effect. Authoritative sources cited in the policy report that ear candling is largely ineffective and may deposit hot wax that can burn the ear canal or tympanic membrane; this safety concern is an explicit contraindication noted in the evidence summaries.
Several systematic reviews summarized in the policy excluded pilot studies, single‑subject designs, mechanical or simulated interventions, or studies with co‑interventions depending on review-specific criteria. These methodological exclusions are noted as part of the rationale for grading the evidence and contribute to the conclusion that many CAM modalities lack high‑quality, generalizable trial data.
Wilderness therapy (also called adventure therapy or outdoor behavioral healthcare) is described as a multifaceted program where wilderness immersion is the primary therapeutic modality. The policy states there are no large‑scale, consistent peer‑reviewed studies demonstrating safety and effectiveness for wilderness therapy; therefore it is considered experimental, investigational, and unproven in this document and would be managed accordingly under investigational/PA processes.
The policy identifies specific therapies for which the peer‑reviewed literature does not demonstrate adequate clinical benefit. Examples include intravenous hydrogen peroxide and other unconventional injectable treatments, and helminthic therapies such as Trichuris suis ova; the document states there is currently insufficient high‑quality evidence to support their safety or effectiveness for the reviewed indications.
The policy lists multiple modalities with insufficient high‑quality evidence to support clinical utility, including polarity therapy, Reiki, and Revici's guided chemotherapy. These are characterized in the document as unsupported by current peer‑reviewed evidence and therefore not established treatment options in the reviewed literature.
The policy cites authoritative guidance and systematic reviews relevant to ear candling and pediatric otitis media: ear candling is reported to be ineffective and potentially harmful (risk of burns), and systematic reviews of CAM for pediatric otitis media conclude CAM is not considered a treatment option for otitis media in children given limited and inconsistent evidence.
The policy references NICE intrapartum guidance stating clinicians should not offer acupuncture, acupressure, or hypnosis during labour; if a woman chooses to use these techniques, clinicians should support her choice but not proactively offer them as standard care. This guidance informs the policy's stance where guideline contraindications or ‘‘do not offer’’ recommendations exist.
This section of the source contains bibliographic references and does not itself make coverage exclusions or policy determinations. The references are provided to support the systematic reviews, guidelines, and evidence summaries cited elsewhere in the policy.
During the 2025 annual review, the policy was updated to remove several example policy statements; specifically, examples for salivary hormone panels, cellular therapy, Laetrile, colonic irrigation/colonic lavage/colonic cleansing were removed. The revision record notes no clinical policy statement changes alongside this operational editing.
Across the document the authors compiled an extensive list of CAM diagnostic tests, systems, and therapeutic modalities that are characterized as experimental, investigational, or unproven. The practical implication is that a large number of tests and therapies (listed throughout the policy) should be treated as investigational or not established for routine coverage absent robust, indication‑specific evidence.
The policy repeatedly emphasizes there is insufficient high‑quality evidence across many complementary and alternative therapies. Systematic reviews and meta‑analyses frequently cite small sample sizes, heterogeneity of interventions and outcomes, short follow‑up, and limited adverse event reporting as reasons the available evidence does not establish clinical utility for numerous modalities.
Multiple systematic reviews summarized in the policy report that craniosacral therapy produced no statistically significant or clinically relevant changes for the assessed conditions. Authors concluded craniosacral therapy was not clinically effective for the conditions reviewed, and some reviews noted future studies were unlikely to alter that conclusion due to biological implausibility and persistent methodological limitations.
The policy lists many therapies with evidence gaps across reviews and systematic analyses. Examples include manual and movement therapies (Feldenkrais, Pilates, Rolfing), various massage modalities, reflexology, Tui Na (Tuina), visceral massage, and art/music/hippotherapy — all described as having insufficient high‑quality evidence or low-certainty findings that preclude definitive conclusions about clinical effectiveness.
Taken together, the policy summarizes that a broad array of modalities have insufficient evidence to support clinical utility. The document repeatedly notes small, heterogeneous trials with methodological weaknesses and limited adverse event reporting, which underpin the cautious or investigational stance toward these modalities.
Where the evidence is insufficient to establish safety and effectiveness — for example, wilderness therapy, antineoplastons, and other listed alternative treatments — the policy describes these interventions as investigational, unproven, or experimental and indicates they would be managed per standard prior authorization and investigational coverage processes if a coverage request is made.
The document reiterates across multiple sections that there is insufficient high‑quality evidence to support clinical utility for many complementary therapies. This repeated conclusion serves as the basis for treating many listed interventions as investigational or not medically necessary absent stronger, well‑designed evidence.
Trichuris suis ova therapy is discussed with reference to multiple RCTs and systematic reviews showing minimal or no therapeutic benefit for Crohn's disease, ulcerative colitis, allergic rhinitis, and other indications; the policy states no consistent clinical benefit has been demonstrated. Revici's guided chemotherapy is also cited as lacking adequate peer‑reviewed evidence to support clinical utility.
The policy groups numerous CAM modalities (herbal supplements, many mind‑body practices, manual therapies, and other alternative approaches) and states that, for most reviewed conditions, there is insufficient or inconsistent evidence of safety and effectiveness. That conclusion supports treating many such modalities as not medically necessary when proposed as primary treatments in place of established therapies.
Professional guidelines and society statements summarized in the policy identify multiple interventions where evidence is limited, conditional, or inconclusive (for example, omega‑3s, various herbal products, music therapy, hypnosis in some contexts). These guideline summaries reinforce the policy's cautious stance and the need to align any covered use with specific, guideline‑supported indications when present.
The references section contains bibliographic citations supporting the evidence summaries and guideline statements in the policy; it does not itself make coverage or ‘‘not medically necessary’’ determinations. Providers and reviewers should consult the cited sources for detailed study‑level data when preparing documentation or prior authorization requests.
Coding — Experimental/Not Covered Codes and Related References
Experimental CPT/HCPCS codesmixedNot Covered
90880
Hypnotherapy
A9152
Single vitamin/mineral/trace element, oral, per dose, not otherwise specified
A9153
Multiple vitamins, with or without minerals and trace elements, oral, per dose, not otherwise specified
G0176
Activity therapy, such as music, dance, art or play therapies not for recreation, related to the care and treatment of patient's disabling mental health problems, per session (45 minutes or more)
H2032
Activity therapy, per 15 minutes
S8940
Equestrian/hippotherapy, per session
S9451
Exercise classes, non-physician provider, per session
T2036
Therapeutic camping, overnight, waiver; each session
T2037
Therapeutic camping, day waiver; each session
Codes considered experimental when used to report chemical hair analysismixedNot Covered
80178
Lithium
82108
Aluminum
82175
Arsenic
82300
Cadmium
82310
Calcium; total
82525
Copper
83018
Heavy metal; quantitative, each, not elsewhere classified
83540
Iron
83655
Lead
83735
Magnesium
1–10 of 17
1/2
Unlisted codes considered experimental when used for CAM methods without assigned codesmixedNot Covered
45399
Unlisted procedure, colon
76498
Unlisted magnetic resonance procedure (eg, diagnostic, interventional)
84999
Unlisted chemistry procedure
86353
Lymphocyte transformation, mitogen (phytomitogen) or antigen induced blastogenesis
86849
Unlisted immunology procedure
90899
Unlisted psychiatric service or procedure
96379
Unlisted therapeutic, prophylactic, or diagnostic intravenous or intra-arterial injection or infusion
96549
Unlisted chemotherapy procedure
97039
Unlisted modality (specify type and time if constant attendance)
Outpatient Physical and Occupational Therapy Services (National)
L33261
Allergy Testing (First Coast)
L33252
Psychiatric Diagnostic Evaluation and Psychotherapy Services (First Coast)
L33624
Psychiatric Inpatient Hospitalization (National Government Services)
1–10 of 23
1/3
Medicare LCD/NCD identifiers referencedmixed
No codes listed
Policy code currency note
Policy noteThis code list may not be all-inclusive because AMA and CMS code updates can occur more frequently than policy updates.
Deleted/Inactive codesDeleted codes and codes not effective at time of service may not be eligible for reimbursement.
Provider actionUse the most appropriate, current codes as of the service date; verify code status if reimbursement is expected.
Provider Actions — Prior Authorization, Documentation, and Billing Guidance
Prior Authorization
Prior Authorization & Billing — General
Coverage and prior authorization requirements vary by benefit plan. Providers must check the member's specific benefit plan document and any applicable prior authorization (PA) processes before submitting requests. In the absence of plan-specific mandates, clinical review may be required to establish medical necessity for services with limited or inconclusive evidence.
Check the patient's benefit plan document (e.g., EOC, SPD, Group Service Agreement) for coverage specifics and any exclusions.
Claims billed without covered diagnosis/procedure codes listed in the applicable Coverage Policy will be denied.
When billing, use the most appropriate codes as of the date of service; unsupported codes may lead to denial.
Prior Authorization
Background — CAM Overview
This section contains extensive references and bibliographic entries used to support the systematic review summaries and guideline citations in the policy. The references themselves do not state coverage exclusions; they serve to document the evidence base the policy authors evaluated.
Definitions and Glossary
CAM classifications
Complementary approachesUsed together with conventional medicine (integrative).
Alternative approachesUsed in place of conventional medicine.
Combination approachesIntegrate two or more therapeutic inputs (e.g., yoga, tai chi, art therapy).
Primary therapeutic inputsNutritional, psychological, physical, or combination-based classifications per NCCIH.
Color therapy definition (chromotherapy)
TermColor therapy (chromotherapy): use of specific wavelengths of visible light (colors) to address various medical conditions.
Revision History and Policy Changes
2025-02-15operational_revision
Removed policy statement examples for salivary hormone panels; cellular therapy; Laetrile; colonic irrigation, colonic lavage and colonic cleansing.
2026-02-15annual_reviewLatest
Annual review performed; references section updated with bibliographic citations and no clinical policy statement changes noted.
2024-11-15focused_review
Policy Summary
PayerCigna
PolicyComplementary and Alternative Medicine
Policy CodePolicy EN0086
Change TypeOperational updates (examples removed); no material clinical changes
Effective DateFeb 15, 2026
Next Review DateFeb 15, 2027
Key ActionRefer to the customer's benefit plan document for coverage details and obtain prior authorization when required by the member's plan.
Acupressure - chemotherapy-induced nausea/vomiting: Acupressure plus antiemetics reduced severity of acute and delayed nausea in breast cancer patients but had inconsistent effects on frequency; small number of trials and heterogeneous protocols.
Issac et al. 2024; 6 RCTs
Alexander technique: Limited evidence: pooled analyses showed no overall significant effect on chronic non-specific neck pain across all time points; some short-term effects seen but studies low quality and conclusions preliminary.
Qin et al. 2024; 2 RCTs + 1 quasi-randomized trial
AMMA Therapy and BELD: No sufficient peer-reviewed evidence to support clinical utility for claimed indications.
Policy notes lack of evidence for BELD and AMMA Therapy
Craniosacral therapy: Multiple systematic reviews report no consistent clinically relevant effects across assessed conditions; authors conclude lack of proven effectiveness.
Amendolara et al. 2024; Ceballos-Laita et al. 2024
Cupping: Evidence suggests possible immediate reductions in pain intensity in some musculoskeletal conditions but overall quality is low with high heterogeneity; effects on function and mental health inconsistent.
Jia et al. 2025; Yiyang et al. 2025; Ma et al. 2018
Multiple systematic reviews exist but are constrained by small samples, risk of bias, heterogeneity, and limited adverse event reporting; currently insufficient high-quality evidence to support clinical utility across many indications.
Policy summaries of yoga reviews.
Other alternative modalities: For modalities such as antineoplastons, Ayurveda, biofield therapies, homeopathy, MRT, ozone therapy, Trichuris suis ova, polarity therapy, Reiki, and many herbal products, current peer-reviewed evidence is insufficient or inconsistent to support safety and effectiveness; many are considered experimental or unproven.
See modality-specific sections and systematic reviews.
Other CAM modalities: Systematic reviews across conditions generally find insufficient or low-quality evidence to recommend these therapies; methodological limitations and heterogeneity limit conclusions.
Multi-therapy systematic reviews summarized in policy.
See NCCN, SIO/ASCO, ESPGHAN/NASPGHAN statements.
Prior Authorization Likely for CAM & Ozone/Intradiscal Therapies
Prior authorization is likely required to establish medical necessity for many complementary and alternative medicine (CAM) services listed as experimental, investigational, or unproven given the limited, low-quality, or inconsistent evidence base. Documented prior conservative therapy, indication, and objective outcome measures strengthen review.
Prior authorization may be requested for interventions with limited evidence to confirm medical necessity.
Include prior conservative care and failed treatment documentation when applicable (see ozone/intradiscal guidance below).
If Medicare beneficiary services are billed, review applicable Medicare NCDs/LCDs — local Medicare policies may impose additional documentation or PA-like requirements.
For ozone and intradiscal ozone therapies, prior authorization is recommended. Evidence is limited and heterogeneous; PA requests should include documentation proving failure of appropriate conservative therapies, specified route/dose/technique, and standardized baseline and follow-up outcome measures.
Document prior conservative care (e.g., physical therapy, medications, injections, duration and dates) and objective measures of failure.
Provide standardized pain and function measures (e.g., VAS, Oswestry Disability Index) with baseline and follow-up timepoints.
Include trial design details or systematic review citations if relying on literature for justification (sample size, follow-up duration, comparator, adverse events).
Prior Authorization
Prior Authorization Likely for Guideline-Limited CAM
Some CAM therapies are guideline-limited or recommended only in specific contexts; prior authorization is likely for these services to verify adherence to guideline criteria and to document clinical justification.
If relying on a professional guideline (e.g., NICE, AAN, ACR, ASCO/SIO), reference the exact recommendation and how the member meets guideline criteria.
Document indication, prior treatments, and rationale when requesting coverage for guideline-limited CAM.
Examples: nonpharmacological strategies in intrapartum care have specific NICE recommendations and restrictions; reference guideline statements in the request.
Note
Medicare Coverage Listings — Review Required
Medicare NCDs and LCDs relevant to CAM services are listed for reference. Providers should review the current Medicare policies for up-to-date coverage and any documentation or local coverage requirements that may affect payment.
National Coverage Determinations (NCDs) include Hair Analysis (190.6) and Transcendental Meditation (30.5) — review effective/revision dates.
Local Coverage Determinations (LCDs) vary by contractor (examples listed for therapy, psychiatry, allergy testing, outpatient services) — review the contractor-specific LCD for current rules.
Note: review the current Medicare policy for the most up-to-date information; LCDs/NCDs may specify documentation or local coverage rules that impact payment.
Note
No Explicit Authorization or Billing Procedure Specified
This section does not specify formal, policy-level documentation or step-therapy rules. There are no explicit universal authorization or billing procedures enumerated here — follow the member's plan, applicable PA portals, and payer instructions for submission requirements.
No universal step therapy sequences are described in this policy excerpt; do not assume specific step-therapy requirements unless stated in the member's plan.
No formal documentation rules are provided in this section — provide comprehensive clinical documentation as requested by payer.
If no PA instructions are available in the Coverage Policy, use standard PA processes and include full clinical records to support medical necessity.
Denial Risk
Denial Risk & Evidence Quality Concerns
Evidence limitations across CAM interventions increase the risk of non-coverage. Low or very low quality evidence, small heterogeneous trials, short follow-up, and sparse adverse event reporting commonly trigger denials for medical necessity or investigational status.
Document clinical rationale addressing evidence gaps: sample size, heterogeneity, risk of bias, follow-up duration, and safety reporting.
Systematic review findings alone may not establish coverage when studies are low quality or contradictory.
Wilderness therapy, antineoplastons, intravenous hydrogen peroxide, and similar interventions are considered experimental/investigational and have a high likelihood of denial.
Denial Risk
Wilderness Therapy — Investigational Stance
Wilderness therapy is considered experimental, investigational, and unproven in this policy due to insufficient evidence of safety and effectiveness. Coverage requests for wilderness therapy are likely to be denied.
Do not expect routine coverage for wilderness or adventure-based therapies; include substantial clinical justification and supporting evidence if requesting review.
If proposing wilderness therapy, document indications, alternatives tried, risks/benefits, and why conventional options are insufficient.
Documentation Required
Evidence & Citation Requirements for Justification
When requesting coverage for CAM services, include citations and concise trial summaries to support medical necessity. Describe key study features and how they apply to the individual patient.
Provide systematic review or RCT citations with sample size, follow-up duration, comparator, primary outcomes, and adverse event reporting.
Summarize how the published evidence relates to the patient's diagnosis and prior treatments.
If relying on trial data, highlight duration of benefit and any limitations (heterogeneity, small sample size, short follow-up).
Documentation Required
Suggested Documentation to Support Coverage Requests
Suggested clinical documentation to support PA and coverage requests includes standardized outcome measures, failed conservative therapies, treatment details, and safety monitoring. Many CAM studies lack standardized measures and long-term follow-up; provide robust clinical data to compensate.
Include baseline and follow-up standardized measures (e.g., VAS, Oswestry Disability Index, WOMAC, validated anxiety/depression scales).
Report adverse events and monitoring plans if proposing interventions with limited safety data.
Address common clinical documentation gaps seen in trials: diagnosis method, consistency of intervention protocol, comparator details, and follow-up duration.
Documentation Required
Suggested Documentation for Ozone Therapies
For ozone therapies specifically, include procedural details and outcome measures when seeking coverage: pain and function scales, prior conservative care, route and dose, and follow-up data. Reviewers expect study-level details if literature is cited.
Document VAS, Oswestry Disability Index, or equivalent pain/function scores at baseline and at regular follow-up intervals.
Specify the ozone administration route (intradiscal, paravertebral, caudal epidural), concentration, and procedural technique.
Provide evidence of failed conservative therapy and timelines (physical therapy, medications, injections, duration).
Attach RCT or systematic review summaries (sample size, comparator, follow-up, adverse events) when citing literature.
Documentation Required
Clinical Documentation Expectations
Clinical documentation expectations: because many CAM studies lacked standardized diagnoses, adequate controls, or long-term follow-up, coverage requests should explicitly address these gaps with objective data and rationale for treatment selection.
Clearly state the clinical diagnosis using accepted diagnostic criteria and cite relevant diagnostic tests.
Explain why standard therapies were inadequate and why the requested CAM therapy is clinically appropriate.
Provide objective outcome measures and planned follow-up to assess effectiveness and safety.
Note
References & Revision Notes — Operational Note
This section contains bibliographic citations and revision notes in the references and revision details; the References list does not itself specify documentation or PA requirements. Use the references to support clinical justification but follow plan-level PA processes.
References provide supporting literature but are not operational PA instructions.
Revision notes indicate no clinical policy statement changes at the listed review dates; they do not alter plan-level authorization rules.
Purported uses
Reported for insomnia, seasonal affective disorder, wound healing, hypertension, diabetes, chronic joint disorders and inflammation.
EvidenceDocument notes insufficient high-quality peer-reviewed evidence to support clinical utility.
Faith healing definition
TermFaith healing: belief that some individuals can channel divine powers to heal injury and disease.
ContextPatients may strongly believe in a healer's divine gifts and focus on illness during consultation.
EvidenceDocument states insufficient high-quality peer-reviewed evidence to support clinical utility.
Hypnosis definition
TermHypnosis: a complementary technique involving focused attention, relaxation, and altered perception intended to enable behavior change and pain modulation.
Purported effectsMay dissociate awareness of pain from sensory experience and has been studied for acute/chronic pain, labor analgesia, anxiety, insomnia, and other conditions.
Evidence limitationsAvailable systematic reviews constrained by heterogeneity, low methodological quality, short follow-up, and insufficient adverse event reporting.
Mirror box therapy definition
TermMirror box therapy (mirror therapy): placement of a mirror in the midsagittal plane to reflect movements of the non-affected limb, creating a visual illusion intended to stimulate motor, sensory, and pain-related brain regions.
Purported usesStudied to improve motor function after stroke, activities of daily living, complex regional pain syndrome, and phantom limb pain.
EvidenceSystematic reviews report heterogeneity and methodological limitations; overall insufficient high-quality evidence for broad clinical utility.
Acupressure / Auricular acupressure definition
TermAcupressure: Traditional Chinese Medicine technique applying pressure to specific points along energy meridians; auricular acupressure applies pressure to ear points.
Purported usesProposed for pain management, anxiety reduction, labor analgesia, insomnia, control of emesis, and weight loss.
EvidenceDocument notes insufficient high-quality evidence overall; some low/moderate-quality RCTs (e.g., auricular acupressure) show immediate postintervention pain reductions but require higher-quality trials.
Acupressure definition (glossary)
TermAcupressure: TCM technique applying pressure to specific meridian points, purported for pain, anxiety, labor, sleep, emesis control, and weight loss.
FormsIncludes body acupressure and auricular (ear) acupressure variants.
Evidence caveatSystematic reviews are limited by small populations, heterogeneous protocols, and low methodological quality.
Alexander technique definition
TermAlexander technique: method of postural reeducation emphasizing conscious control of posture and breathing to correct habitual movement patterns.
Purported usesStudied for recurrent low back pain and balance, and investigated for neck pain and Parkinson's-related function.
EvidenceCurrent evidence insufficient; systematic reviews limited by few studies, low quality, and heterogeneity.
TermBELD (Bio Photonic Lymphatic Drainage Treatment): a device-based proprietary intervention claiming to remove lymphatic blockages and decongest tissues.
ClaimsManufacturer/advocacy sources claim benefits for lumps, chronic pain, allergies, infections, and systemic conditions.
EvidencePolicy states a lack of published, peer-reviewed evidence to support safety or efficacy for any indication.
Cupping definition (general)
TermCupping: placement of cups (glass, bamboo, etc.) on skin to create local hyperemia or hemostasis; forms include dry/retained, flash, wet/bleeding, moving, medicinal, and combined cupping.
Purported usesUsed for pain conditions (e.g., fibromyalgia, low back pain, knee osteoarthritis), respiratory conditions, herpes zoster, and others.
Evidence noteSystematic reviews (e.g., 72 RCTs; 5720 participants) report possible pain reduction but overall low or very‑low quality evidence with high heterogeneity.
Craniosacral therapy definition
TermCraniosacral therapy: non-invasive mindful palpation of fascial tissues between the cranium and sacrum, derived from osteopathic techniques, intended to release myofascial structures and normalize craniosacral rhythms.
Purported usesProposed for tension headaches, migraines, low back and neck pain, fibromyalgia, pelvic girdle pain, and related stress/mental health issues.
EvidenceMultiple systematic reviews report insufficient high-quality evidence to support clinical utility.
Cupping definition (evidence note)
Evidence summaryLarge cumulative reviews (e.g., Cao et al. 2012, 135 RCTs) report many studies but high risk of bias and heterogeneity; authors caution lack of well‑designed trials.
Safety noteAdverse events reporting variable; wet cupping associated with fainting, skin laceration, and circulatory instability in some reports.
Clinical implicationDespite numerous trials, study quality limitations preclude firm conclusions on effectiveness.
Reflexology definition
TermReflexology: application of targeted pressure to areas of the hands or feet purported to affect corresponding organs and systems.
Purported usesClaimed for pain, anxiety, fatigue, sleep disturbances, labor outcomes, and multiple chronic conditions.
EvidenceDocument states insufficient high-quality evidence; systematic reviews constrained by small, heterogeneous studies.
Tui Na (Tuina) definition
TermTui Na (Tuina): Chinese manipulative therapy using rubbing, pressing, kneading, rolling, and other techniques to treat musculoskeletal and other conditions.
Purported usesUsed for headaches, GI symptoms, insomnia, diabetic peripheral neuropathy, and musculoskeletal complaints; may be combined with other therapies.
EvidenceSystematic reviews report mixed findings with limitations due to study quality and heterogeneity.
Ear candling definition
TermEar candling: insertion of a lit hollow candle into the ear canal purported to remove earwax and debris.
Safety and efficacyAuthoritative sources report it is largely ineffective and may deposit hot wax causing burns to the ear canal and tympanic membrane.
Policy stanceDocument identifies ear candling as ineffective with potential harm; contraindicated per some societies for pediatric otitis media contexts.
Visceral Massage definition
TermVisceral massage (visceral manipulation): massage of internal muscular viscera proposed to relieve pain and improve organ mobility and function (e.g., postpartum adhesions).
Purported benefitsProposed to relieve back/abdominal pain, migraines, and improve function by addressing adhesions.
EvidencePolicy states insufficient high-quality evidence to support clinical utility.
Art Therapy / AVAT definition
TermArt therapy / AVAT: active visual art therapy involving hands-on artistic activities (drawing, painting, sculpting) used as psychotherapeutic interventions.
Purported usesApplied to improve emotional well-being, reduce anxiety/depression, and enhance QOL across diverse patient groups.
EvidenceSystematic reviews report therapeutic benefits in some outcomes but are limited by low study quality and heterogeneous interventions; more high-quality trials needed.
Hippotherapy / Equine-assisted therapy definition
TermHippotherapy / Equine-assisted therapy: therapeutic use of horse movement by a trained clinical team to influence posture, balance, neuromuscular control, and psychosocial outcomes.
Purported usesStudied for cerebral palsy, multiple sclerosis, stroke rehabilitation, and neuromotor disabilities to improve balance, gait, and function.
EvidenceSystematic reviews report some positive effects but are limited by small sample sizes, heterogeneity, and lack of long-term data.
Music Therapy definition
TermMusic therapy: use of music-based techniques (improvisation, receptive listening, songwriting) to address emotional, cognitive, and physical health domains.
Purported usesStudied for chronic pain, dementia, PTSD, perioperative recovery, aphasia, anxiety, depression, and cancer support.
EvidenceExisting systematic reviews show constrained evidence due to small samples, heterogeneity, and limited long-term follow-up.
Pet Therapy / Animal-assisted therapy definition
TermPet therapy / Animal-assisted therapy (AAT): use of animals (commonly dogs, cats) to support psychological and physical rehabilitation and improve QOL.
Purported effectsReported to reduce stress biomarkers and improve mood, social engagement, and rehabilitation outcomes.
EvidenceSystematic reviews constrained by heterogeneity and low methodological quality; insufficient high-quality evidence for broad clinical recommendations.
Qigong definition
TermQigong: traditional Chinese practice combining movement, meditation, and regulated breathing intended to influence Qi, circulation, immune function, and symptoms.
Purported usesApplied for stroke prevention, cancer symptoms, cervical spondylosis, low back pain, COPD, diabetes, fatigue, frailty, and sleep.
EvidenceSystematic reviews report some positive findings (e.g., cervical spondylosis) but are limited by short follow-up, small trials, and heterogeneity.
Qigong longevity definition
TermQigong longevity: a qigong variant emphasizing movement, meditation, and breathing to improve circulation, immune function, and longevity-related outcomes.
Evidence caveatDocument indicates insufficient high-quality evidence to support clinical utility across indications.
ExamplesRoutines include Ba Duan Jin, Yi Jin Jing, and Wu Qin Xi in reviewed trials.
Wilderness therapy definition
TermWilderness therapy: multi-faceted treatment using immersion in wilderness with structured individual/group therapeutic work (also called adventure therapy or therapeutic camping).
Purported usesApplied for behavioral, psychological, psychosocial, and substance abuse issues in adolescents and young adults.
Evidence and safetyNo large-scale consistent outcomes demonstrated; considered experimental, investigational, and unproven with potential safety concerns.
Yoga definition
TermYoga: meditative movement practice involving physical postures (asanas), breathing techniques (pranayama), and meditation (dhyana) intended to improve flexibility, strength, relaxation, and stress reduction.
Purported usesStudied for hypertension, anxiety, depression, cancer-related fatigue, low back pain, pregnancy outcomes, and neurological conditions.
EvidenceMultiple systematic reviews exist but are limited by small samples, heterogeneity, and variable quality; overall insufficient high‑quality evidence for many indications.
Isopathy definition (homeopathy variant)
TermIsopathy: a homeopathic approach using the causal agent as the therapeutic agent.
ContextMentioned in homeopathy reviews (e.g., for allergic rhinitis) where trials using isopathy were heterogeneous and unsuitable for meta-analysis.
EvidenceHomeopathy evidence overall described as heterogeneous and low-quality; no firm conclusions on efficacy.
Traumeel (Tr14) definition — homeopathic combination formula
TermTraumeel (Tr14): a homeopathic combination formula containing botanical and mineral substances proposed to have anti-inflammatory properties.
Uses studiedInvestigated for musculoskeletal injuries and pain with small observational studies and limited RCT data.
EvidenceAvailable studies small and heterogeneous; additional larger, long-term trials needed to establish safety and effectiveness.
TermIntradiscal/Paravertebral/Ozone therapy: injection or infiltration of an oxygen-ozone mixture into discal or paravertebral tissues to reduce pain from herniated discs or related conditions.
EvidenceSystematic reviews/meta-analyses report some short-term improvements in VAS and ODI after failed conservative care but note heterogeneity, variable study quality, and inconsistent adverse event reporting.
Clinical implicationStudies often performed after failed conservative therapy; additional high-quality RCTs recommended before broad clinical adoption.
Reiki definition
TermReiki: hands-on or near-body energy-directed practice rooted in Eastern beliefs aiming to support healing by directing energy fields.
Purported usesStudied for anxiety, pain, QOL and other outcomes across diverse patient groups.
EvidenceSystematic reviews report insufficient high-quality evidence to support clinical utility.
Trichuris suis ova therapy definition
TermTrichuris suis ova therapy: oral administration of pig whipworm eggs as helminthic therapy intended to modulate immune responses.
EvidenceRCTs and systematic reviews show minimal or no consistent therapeutic benefit for Crohn's disease, ulcerative colitis, and other indications; some transient symptomatic effects observed but not sustained.
SafetyAdverse events (e.g., GI symptoms) reported in some trials; no superiority over placebo for remission in recent RCTs.
CAM umbrella definition
TermCAM umbrella: broad group of therapies including herbal remedies, dietary supplements, mind–body practices (yoga, meditation, Tai Chi, Qigong), manual therapies (massage, chiropractic), and other modalities (acupuncture, aromatherapy, homeopathy).
ClassificationIncludes nutritional, psychological, physical, and combination approaches; some practices (Ayurveda, homeopathy, naturopathy) span categories.
Evidence overviewMany CAM therapies lack sufficient, high-quality peer-reviewed evidence demonstrating safety and effectiveness; clinical recommendations vary by guideline and indication.
NCCN Category definitions (Category 1 / 2A)
Category 1NCCN Category 1: high-level evidence and uniform NCCN consensus supporting the intervention.
Category 2ANCCN Category 2A: lower-level evidence but uniform NCCN consensus supporting the intervention.
Usage noteNCCN uses these categories for nonpharmacologic/integrative interventions (examples cited in policy for yoga, massage, hypnosis, imagery).
References — bibliographic references
References listComprehensive bibliographic references for systematic reviews, meta-analyses, and guideline sources are provided in the document (reference numbers and citations listed).
Use for justificationProviders and reviewers should reference the cited systematic reviews and guidelines when evaluating claims or making coverage determinations.
Examples includedReferences include key reviews on yoga, cupping, mirror therapy, music therapy, and qigong among many others (see reference list sections).
Focused review completed; no clinical policy statement changes noted.
2025-02-15references_update
References and revision notes updated; no prior authorization requirements specified in the references section.