CurrentCignaPolicy N/A

Cigna Medical Coverage Policy- Therapy Services Acupuncture

Defines when acupuncture services are considered medically necessary, not medically necessary, or experimental for members when acupuncture coverage exists in the benefit plan; provides documentation, treatment planning, and outcome measurement guidance and literature review context. This part covers indications, medical necessity factors, treatment planning/outcomes, documentation and literature evidence (partial document, part 1 of 5).

Policy Summary

PayerCigna

PolicyCigna Medical Coverage Policy- Therapy Services Acupuncture

Policy CodePolicy N/A

Change TypeNo material change

Effective Date4/15/2025

Next Review Date4/15/2026

Key ActionDocument an initial evaluation and each treatment session with required elements (history, exam, plan of care, measurable goals, treatment details, outcomes and provider credentials) per the policy's documentation requirements.

POLICY UPDATE CHANGES

No material clinical or coverage changes noted in this update (has_material_change=false).

5Listed covered indications (conditional)

3Not medically necessary categories listed

1Experimental therapy listed

4Required documentation sections

Acupuncture CPT codes listed

4Injection CPTs listed as unproven for acupuncture point injection

Coverage Summary

This policy defines when acupuncture services are covered, not covered, or considered experimental for members whose benefit plan includes acupuncture. Acupuncture is considered medically necessary for specific indications (including tension-type headache and migraine; musculoskeletal joint and soft tissue pain causing functional deficit; and certain nausea indications when co-managed by a medical physician) when ALL specified medical necessity and treatment planning/outcome criteria are met (see policy for the full list).

Acupuncture is considered not medically necessary for services intended to improve or maintain general physical condition, for maintenance acupuncture when significant therapeutic improvement is not expected, for services that do not require the skills of a qualified provider (e.g., independently performed activities or home exercise programs), and for any other indication not listed as medically necessary (including infertility and recurrent pregnancy loss).

Acupuncture point injection therapy (pharmaceuticals or biologics injected into acupuncture points) is considered experimental, investigational or unproven due to insufficient evidence of safety and efficacy.

Coverage under this policy applies only when acupuncture benefits are included in the member's applicable benefit plan; benefits are determined by the plan document and applicable laws/regulations. Effective date: 4/15/2025. Next review date: 4/15/2026.

Quick Reference — Thresholds & Operational Items

Therapeutic trial durationInitial trial 2–4 weeks; if no improvement documented after 2–4 weeks consider alternative treatment plan

FOM MCID requirementWhen used, Functional Outcome Measures (FOMs) must demonstrate Minimal Clinically Important Difference (MCID) from baseline on periodic reassessments

Typical WOMAC durabilityKnee OA improvements may persist ~3–6 months post-treatment (varies by comparator and study)

Note about MCID examplesMCID varies by measure and study; some trials exceed MCID (e.g., VAS/HFAQ/WOMAC) while others do not — correlate with clinical presentation

Required provider qualificationsServices must be delivered by a qualified provider of acupuncture acting within scope of state/federal license, certification, or registration

Required CPT codesBill acupuncture with CPT codes 97810, 97811, 97813, 97814 (acupuncture point injection CPTs 20550–20553 considered experimental/unproven)

Medical‑Necessity Criteria

Medically Necessary

If coverage for acupuncture services are available in the applicable benefit plan document, acupuncture may be provided as treatment for ANY of the following conditions when ALL of the medical necessity factors and ALL of the treatment planning /outcomes listed below are met:

Tension-type Headache; Migraine Headache with or without Aura

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

Nausea Associated with Pregnancy (only when co-managed)

Post-Surgical Nausea (only when co-managed)

Nausea Associated with Chemotherapy; (only when co-managed)

Coding

Acupuncture CPT codes referencedCPTCovered

97810	Acupuncture, 1 or more needles; without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
97811	Acupuncture, 1 or more needles; without electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, when performed
97813	Acupuncture, 1 or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
97814	Acupuncture, 1 or more needles; with electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, when performed

Covered CPT (when criteria met)CPTCovered

97810	Acupuncture, 1 or more needles; without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient.
97811	Acupuncture, each additional 15 minutes; without electrical stimulation, with re-insertion of needle(s) (List separately in addition to code for primary procedure).
97813	Acupuncture, 1 or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient.
97814	Acupuncture, each additional 15 minutes; with electrical stimulation, with re-insertion of needle(s) (List separately in addition to code for primary procedure).

Experimental/Unproven CPT (Acupuncture Point Injection)CPTExperimental

20550	Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar 'fascia') — considered experimental/unproven when used to report acupuncture point injection therapy.
20551	Injection(s); single tendon origin/insertion — considered experimental/unproven when used to report acupuncture point injection therapy.
20552	Injection(s); single or multiple trigger point(s), 1 or 2 muscles — considered experimental/unproven when used to report acupuncture point injection therapy.
20553	Injection(s); single or multiple trigger point(s), 3 or more muscles — considered experimental/unproven when used to report acupuncture point injection therapy.

Covered ICD-10-CM Diagnosis CodesICD-10Covered

G43.001-G43.919	Migraine.
G44.201	Tension-type headache, unspecified, intractable.
G44.209	Tension-type headache, unspecified, not intractable.
G44.211	Episodic tension-type headache, intractable.
G44.219	Episodic tension-type headache, not intractable.
G44.221-G44.229	Chronic tension-type headache.
G44.301-G44.329	Post traumatic headache.
G89.11	Acute pain due to trauma.
G89.12	Acute post-thoracotomy pain.
G89.18	Other acute postprocedural pain.

1–10 of 40

1/4

Not Medically Necessary ICD-10-CMICD-10Not Covered

All other codes

All ICD-10-CM diagnosis codes not specifically listed as 'Considered Medically Necessary' in this policy portion.

Provider Actions & Documentation

Documentation Required

Initial evaluation documentation required

Initial evaluation must document clinical history, exam, medical decision-making; subjective historical evaluation (e.g., 10 questions); standardized and non-standardized tests; baseline functional status; working diagnosis; plan of care with frequency/duration; measurable goals; prognosis and discharge plan.

Clinical history, examination, and medical decision‑making
Subjective historical evaluation using standardized method (e.g., 10 questions)
Specific standardized and non‑standardized tests and assessments
Interpretation/synthesis of findings and working diagnosis
Plan of care with specific techniques, frequency and duration
Functional, measurable, time‑framed short‑ and long‑term goals
Prognosis and estimated discharge plan

Background & Evidence Summary

Acupuncture is a complementary medicine practice that stimulates specific anatomic skin locations by penetrating fine needles to relieve pain or treat disease; stimulation may be manual or via electrical stimulation (electroacupuncture).

Multiple centrally mediated mechanisms have been proposed (e.g., release of endogenous opioids, diffuse noxious inhibitory control, descending serotonergic pathways, autonomic modulation of inflammation), but the precise physiological mechanism remains not definitively established.

The FDA considers acupuncture safe when performed by qualified practitioners using sterile, single-use, nontoxic needles labeled for single use; overall acupuncture has a relatively low rate of serious adverse events when performed per recommendations. Licensure or registration for acupuncture providers exists in most states, but scope of practice and which practitioner types may deliver acupuncture vary by jurisdiction.

A typical course of acupuncture may last several weeks; there is no consensus on optimal number of treatments, but clinical improvement should be expected. If no improvement after an initial trial of two–four weeks is documented, an alternative treatment plan should be considered, and continuation should be contingent on objective evidence of progress toward defined functional goals.

Evidence Source	Key Finding
Vickers et al. (2012) meta-analysis	Acupuncture superior to sham and no‑acupuncture controls for chronic pain; modest effect vs sham (≈0.15–0.23 SD) and larger vs no‑acupuncture (≈0.42–0.57); n≈17,922
NICE guideline (2021)	Mixed‑quality evidence: short‑term clinically important benefits vs sham/usual care for pain, QoL and function in some comparisons; certainty variable across outcomes and timepoints
Knee osteoarthritis (Cochrane & recent reviews)	May improve pain and function up to ~3–6 months post‑treatment versus sham, usual care, or some comparators; evidence low to very low certainty; adverse events generally mild (e.g., hematoma)
Tension‑type headache / Migraine (Cochrane reviews)	Trials/meta‑analyses show reduced headache frequency and pain vs routine care; mixed results vs sham with some trials favoring acupuncture; considered a valid nonpharmacologic option
Low back pain (systematic reviews/AHRQ)	Modest short‑term pain relief and some functional improvement vs sham or no treatment; certainty ranges low to moderate; effects often small and sometimes not clinically important
Chronic sciatica (Tu et al. 2024 RCT)	Acupuncture reduced leg pain (VAS) and ODI vs sham with benefits persisting to 52 weeks; no serious adverse events reported
Chemotherapy‑induced peripheral neuropathy (CIPN) reviews/meta‑analyses	Multiple reviews suggest benefit for pain, QoL and nerve conduction; evidence quality low to very low; acupuncture+electrical stimulation may be most effective
Nausea / P6 stimulation and CINV / PONV (Cochrane & trials)	Acupuncture and P6 stimulation effective for prevention/treatment of postoperative and chemotherapy‑induced nausea/vomiting; evidence often low certainty but consistent across many RCTs
Breast cancer / AI‑related arthralgia (Hershman et al., Mao/ASCO guidance)	RCTs and guidelines recommend acupuncture for aromatase inhibitor‑related joint pain; randomized trial showed reduced pain at 52 weeks
Acupuncture point injection therapy	Insufficient peer‑reviewed evidence to support safety and efficacy; considered experimental/investigational/unproven (policy conclusion)
Systematic evidence syntheses (multiple SRs/MAs)	Heterogeneous literature across conditions: benefits often small, variable durability, generally few serious adverse events; many trials small/low quality
Temporomandibular disorder (Busse et al. 2023)	Guideline issued conditional recommendation in favor of acupuncture for chronic TMD pain based on comparative effectiveness review
Durability analyses (meta‑analyses)	Some conditions (e.g., KOA, chronic pain) show effects lasting 3–6 months post‑treatment in pooled analyses, though certainty varies
Cancer pain / supportive care SRs	Systematic reviews find limited but suggestive evidence for symptom benefits (pain, nausea, fatigue) in cancer patients; trial sizes small and quality variable
Coding / Experimental use note	Acupuncture point injection when reported with standard injection CPTs (20550‑20553) is considered experimental/unproven

Definitions

Acupuncture point injection therapy: Procedure where pharmaceuticals or biological products are injected into acupuncture points; considered experimental/investigational/unproven by this policy.

Functional Outcome Measures (FOM): Standardized tests/measures used to quantify baseline and changes in function; when used should demonstrate Minimal Clinically Important Difference (MCID) from baseline through periodic reassessments.

CIPN: Chemotherapy-induced peripheral neuropathy.

AI-related joint pain: Aromatase inhibitor-induced arthralgia in breast cancer patients.

P6: Neiguan acupuncture point used for nausea/vomiting control.

Acupuncture Point Injection Therapy: Injection at acupuncture points; considered experimental/unproven in this policy due to insufficient peer-reviewed evidence of safety and efficacy.

Medicare Determinations

Name	Number	Type
Acupuncture	NCD 30.3	NCD
Acupuncture for Fibromyalgia	NCD 30.3.1	NCD
Acupuncture for Osteoarthritis	NCD 30.3.2	NCD
Decision Memo for Acupuncture for Chronic Low Back Pain	CAG-00452N	LCD

Revision History

2025-04-15effective

Policy effective date (Cigna Medical Coverage Policy - Therapy Services Acupuncture).

2026-04-15planned_reviewLatest

Next scheduled policy review date.

Policy Summary

PayerCigna

PolicyCigna Medical Coverage Policy- Therapy Services Acupuncture

Policy CodePolicy N/A

Change TypeNo material change

Effective Date4/15/2025

Next Review Date4/15/2026

On This Page

Medically Necessary Acupuncture Services

When clinical criteria above are met, the following procedural and diagnostic coding is acceptable for covered acupuncture services.

ALL of the following

Covered procedural codes include CPT codes for acupuncture services (e.g., acupuncture with or without electrical stimulation) as specified in the Coding Information section of this policy.
Covered diagnosis codes include the ICD-10-CM ranges and specific codes listed in the Coding Information section that correspond to the covered indications above.

Not Medically Necessary

Acupuncture is considered not medically necessary for any of the following indications:

Treatment intended to improve or maintain general physical condition

Maintenance acupuncture services, when significant therapeutic improvement is not expected

Services that do not require the skills of a qualified provider of acupuncture including but not limited to:

Activities and services that can be practiced independently and can be self-administered safely and effectively.

Home exercise programs that can be performed safely and independently to continue therapy without skilled supervision.

Acupuncture for any other indication, including infertility and recurrent pregnancy loss, is considered not medically necessary.

Experimental, Investigational, Unproven

Acupuncture point injection therapy is considered experimental, investigational or unproven.

Acupuncture point injection therapy (injection of pharmaceuticals, vitamins, herbal extracts, or other biologics into acupuncture points) is considered experimental, investigational, or unproven and is not covered.

Provider Qualifications

Provider Qualifications (consolidated):

A majority of states provide licensure or registration for acupuncture practitioners; those who may be authorized, depending on jurisdiction, include licensed acupuncturists (LAc), medical/osteopathic physicians (MD/DO), chiropractors (DC), naturopaths (ND), oriental medicine doctors (OMD), podiatrists (DPM), dentists (DDS/DMD), nurse practitioners (NP), and physician assistants (PA).

Acupuncture should be performed by qualified practitioners consistent with state scope-of-practice and licensing requirements.

The FDA requires use of sterile, single-use, nontoxic needles; qualified practitioners must adhere to these requirements.

Documentation of practitioner qualifications, licensure, and scope of practice should be maintained in the medical record to support medical necessity and billing.

Documentation Required

Treatment session documentation required

Each treatment session must document date, specific treatments that match billed procedure codes, total treatment time, patient response, skilled reassessment, objective progress toward goals, barriers to progress, and treating clinician name/credentials. Bill acupuncture services using CPT codes 97810, 97811, 97813, 97814 when applicable.

Date of treatment
Specific treatment(s) provided that match the procedure codes billed
Total treatment time
Patient's response to treatment
Skilled ongoing reassessment of progress toward goals
Objective, measurable progress toward goals
Barriers to expected progress or changes to plan of care
Name and credentials of treating clinician
Billed CPTs for acupuncture: 97810, 97811, 97813, 97814

Documentation Required

Use of outcome measures and progress monitoring

Monitor and document outcome measures and progress including pain (VAS), interference with activities, validated functional outcome measures (FOMs) with MCID when available, duration of relief, medication/resource use, ROM, tenderness, observation, and barriers to expected progress to support continuation or withdrawal of treatment.

Pain level per VAS (1–10) and symptom frequency
Reported interference with daily functional activities
Validated Functional Outcome Measures (FOMs) with MCID when applicable
Length of time of relief after treatment
Medication or other resource use changes
Range of motion (ROM) and tenderness on palpation
Observation (behavior, mobility, appearance of affected area)
Document barriers to expected progress (e.g., comorbidities, age, socio‑economic factors)

Billing Rule

Use appropriate CPT and ICD-10 codes and meet policy clinical criteria

Providers must bill acupuncture with the appropriate CPT codes (97810, 97811, 97813, 97814) and submit a covered ICD‑10‑CM diagnosis from the list in the policy. In addition, services must meet the policy's clinical medical necessity and treatment planning/outcome criteria to be considered medically necessary.

Billed CPTs: 97810, 97811, 97813, 97814
An applicable covered ICD‑10‑CM diagnosis code from the policy list must be documented
Treatment must meet the policy clinical criteria (medical necessity factors and treatment planning/outcome factors)

Prior Authorization

Coverage dependent on benefit plan

Coverage for acupuncture is available only when the member's applicable benefit plan includes acupuncture services. Claims submitted without covered diagnosis or procedure codes under this policy will be denied as not covered.

Services covered only if included in the member's applicable benefit plan document
Claims without covered diagnosis/procedure codes under this policy will be denied as not covered

Denial Risk

Do not report acupuncture point injection with standard injection CPTs

Acupuncture point injection therapy is considered experimental/unproven. CPT codes 20550, 20551, 20552, and 20553 are considered experimental/unproven when used to report acupuncture point injection therapy and will not be accepted as medically necessary for that purpose.

Do not report acupuncture point injection using CPTs 20550, 20551, 20552, 20553 for coverage — these uses are considered experimental/unproven
Acupuncture point injection therapy lacks sufficient evidence on safety and efficacy

Documentation Required

Provider qualification requirement

Acupuncture services must be provided by a qualified acupuncture provider acting within the scope of their license, certification, or registration as regulated by federal and state governments. Benefits for services provided by these providers may also depend on the member's benefit contract language.

Provider must be licensed/certified/registered and practice within their state/federal scope of license
Benefits may depend on the member's specific benefit contract language