CurrentHealth NetPolicy N/A

Acupuncture and Chiropractic Care Coverage

Describes Health Net coverage, limitations, and patient access for acupuncture and chiropractic services through American Specialty Health Plans of California (ASH Plans); applies to members selecting ASH network providers.

Policy Summary

PayerHealth Net

PolicyAcupuncture and Chiropractic Care Coverage

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionMembers may select ASH Plans network chiropractors or acupuncturists without a referral; contact ASH/Health Net or consult the Evidence of Coverage for authorization requirements.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

20maximum visits per calendar year (per therapy)

S20office visit copayment (as listed)

1-800-275-4737Health Net contact phone number

chronic low back painMedicare-covered acupuncture limited to

Coverage Criteria for Acupuncture and Chiropractic Services

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Covered Services and Visit Limits

Covered when services are provided by ASH Plans network providers and are for covered conditions:

General coverage: Initial exam, follow-up visits, and reexaminations for covered conditions are covered.up to 20 visits per calendar year

Office visit copayment applies as listed; member should use ASH network providers.

The acupuncture and chiropractic programs exclude items and services that are not part of therapeutic care delivered by ASH Plans network providers. Specifically, excluded items include devices, personal and comfort items (for example, air conditioners, air purifiers, therapeutic mattresses, appliances, and similar comfort items), and durable medical equipment and supplies. Diagnostic imaging is excluded from these program benefits, including MRI, CT scans, and thermography. These items and services are not payable under the acupuncture or chiropractic programs and may instead be considered under the medical benefits portion of the member's plan per the Evidence of Coverage.

Exams and treatments that are not intended for neuromusculoskeletal or musculoskeletal-related disorders are not covered under the acupuncture or chiropractic programs. The programs are limited to services for musculoskeletal/neuromusculoskeletal conditions, pain, nausea when indicated, and other specifically covered conditions; any evaluation or therapy performed for unrelated reasons is excluded. If a service or supply is excluded under these programs, it may be considered under the plan's medical benefits as described in the member's Evidence of Coverage.

Provider Actions, Network Access, and Denial Risks

Note

Network access and referrals

Members may select ASH Plans network chiropractors or acupuncturists without a referral. Contact ASH/Health Net or consult the member's Evidence of Coverage (EOC) for plan-specific authorization, copayment, and visit limits.

No PCP referral required to see ASH network chiropractors or acupuncturists.
Contact Health Net Member Services at 1-800-275-4737 (TTY: 711) for questions or authorization details; hours vary seasonally (Oct–Mar: daily 8 a.m.–8 p.m.; Apr–Sep: Mon–Fri 8 a.m.–8 p.m.).

Note

Provider contact and actionable note

For questions about accessing providers or an actionable provider note, contact Health Net Member Services or refer to the member's Evidence of Coverage. After-hours messages are accepted.

Health Net phone: 1-800-275-4737 (TTY: 711).
After-hours messaging system available; include date/time and member identifiers when leaving messages.

Note

EOC and contact

Consult the member's Evidence of Coverage (EOC) for plan-specific copayment amounts, visit limits, and covered visit types. Health Net can clarify coverage for emergency, urgent care, or authorized out-of-network referral visits.

EOC lists copayment and visit variations by plan.
Medicare-covered chiropractic and acupuncture services have specific limits (e.g., Medicare acupuncture limited to chronic low back pain).

Denial Risk

Exclusion-based denials and documentation

Services or supplies excluded under the acupuncture or chiropractic programs may be denied; some excluded items might be covered under the plan's medical benefits—submit documentation and consider alternative claim processing when applicable.

If a service is excluded under the ASH program, check the member's medical benefits for possible coverage.
When appealing or submitting for alternate benefit consideration, include complete clinical documentation and rationale.

Background

Health Net offers acupuncture and chiropractic services through a partnership with American Specialty Health Plans of California, Inc. (ASH Plans). These programs provide access to ASH network chiropractors and acupuncturists for covered musculoskeletal and related disorders, including care for pain and certain indications such as nausea when specified in plan materials. Members should consult the Evidence of Coverage for plan-specific details and benefit limits.

Service Scope and Definitions

inv-09: Acupuncture/Chiropractic service scope

Intended clinical conditionsServices and exams are intended for musculoskeletal and related disorders, pain, nausea, and other covered conditions.

Diagnostic imagingDiagnostic scanning (MRI, CT, thermography) is not covered under the acupuncture/chiropractic programs.

Service boundaries — excluded itemsDevices, personal and comfort items (e.g., air conditioners, air purifiers, therapeutic mattresses), vitamins/minerals/supplements, durable medical equipment, and appliances are excluded.

Service boundaries — unrelated treatmentsExams and treatments unrelated to neuromusculoskeletal (musculoskeletal) disorders are excluded from these programs.

Plan handling of excluded servicesServices or supplies excluded under the acupuncture or chiropractic care programs may be considered under the member's medical benefits per the plan Evidence of Coverage.

Policy Summary

PayerHealth Net

PolicyAcupuncture and Chiropractic Care Coverage

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionMembers may select ASH Plans network chiropractors or acupuncturists without a referral; contact ASH/Health Net or consult the Evidence of Coverage for authorization requirements.

SourceLink

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