CurrentHumanaPolicy CP2021001

Acupuncture for Chronic Lower Back Pain

Billing requirements and reimbursement guidelines for Humana Medicare Advantage plans covering acupuncture (including dry needling) for chronic lower back pain for dates of service 2022 and later; applies to providers submitting claims to Humana MA plans (not supplemental non‑Medicare benefits).

Policy Summary

PayerHumana

PolicyAcupuncture for Chronic Lower Back Pain

Policy CodePolicy CP2021001

Change TypeNo material change

Effective DateJan 1, 2022

Next Review Date

Key ActionSubmit claims consistent with plan medical necessity, reasonableness, and applicable referral or authorization requirements; practitioners meeting state licensure and plan participation requirements may bill for acupuncture for cLBP.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

20max sessions / year (2022+)

PCP exemptPCP exemption (2022–2025)

2022Effective year

Coverage Criteria for Acupuncture

Coverage criteria for acupuncture for cLBP

Covered when ALL of the following are met:

Acupuncture (including dry needling) for chronic lower back pain (cLBP) is a covered service under Humana MA plans consistent with CMS guidance for Original Medicare.

Services are furnished for the same diagnoses covered by Original Medicare for acupuncture for cLBP and reported consistent with applicable CMS transmittals and Internet-only Manuals, except as noted in this policy.

Claims are subject to plan requirements including medical necessity, reasonableness, and any applicable referral or authorization requirements.

Practitioner meets applicable state acupuncture licensure and Humana plan participation requirements and may submit claims for dates of service on or after January 1, 2022 (coverage is not limited to Original Medicare practitioner types).

Policy Summary

PayerHumana

PolicyAcupuncture for Chronic Lower Back Pain

Policy CodePolicy CP2021001

Change TypeNo material change

Effective DateJan 1, 2022

Next Review Date

SourceLink

On This Page

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Claims Submission and Provider Eligibility

Documentation Required

Claims submission, provider eligibility, and same-day service handling

Claims for acupuncture for chronic low back pain are processed subject to plan requirements including medical necessity, reasonableness, and any applicable referral or authorization requirements. For dates of service on or after Jan 1, 2022, providers who meet applicable state acupuncture licensure and Humana plan participation requirements (not limited to Original Medicare practitioner types) may submit claims. Humana treats multiple services furnished the same day as a single session.

Claims are subject to requirements of medical necessity, reasonableness, and applicable referral or authorization requirements.
For dates of service on or after January 1, 2022, practitioners who satisfy applicable state acupuncture licensure and Humana plan participation requirements may submit claims (not limited to Original Medicare practitioner types).
Humana treats all services furnished the same day under the acupuncture for cLBP benefit as one session.

OpenPayer

Acupuncture for Chronic Lower Back Pain

Coverage Criteria for Acupuncture

Coding, Modifiers, and Limits

Claims Submission and Provider Eligibility

Definitions and Modifier Notes