CurrentHumanaPolicy CP2021001

Acupuncture for Chronic Lower Back Pain

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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

Last ReviewDec 1, 2025

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)

2022

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CurrentHumanaPolicy CP2021001

Acupuncture for Chronic Lower Back Pain

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Get alerted when Policy CP2021001 changes without checking for updates manually.

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Policy Summary

PayerHumana

PolicyAcupuncture for Chronic Lower Back Pain

Policy CodePolicy CP2021001

Change TypeNo material change

Effective DateJan 1, 2022

Last ReviewDec 1, 2025

Next Review Date

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

20max sessions / year (2022+)

PCP exemptPCP exemption (2022–2025)

2022

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).

Humana treats multiple acupuncture services furnished the same day as a single session for counting toward session limits.

Session limits: up to 20 sessions per calendar year are covered for dates of service 2022 and later.

PCP exceptions (choose applicable depending on date and plan)

For 2022 through 2025, the 20‑session limitation does NOT apply to services rendered by the patient’s primary care provider (PCP).
For 2026, application of the 20‑session limitation to services rendered by the patient’s PCP varies by plan: for Humana Group MA plans the limit does not apply; for Humana Individual MA plans the limit applies.

Modifier reporting: Humana MA plans do not require providers to report modifier KX for acupuncture visits 13 through 20 in any calendar year, despite CMS billing guidance for Original Medicare.

Coding, Modifiers, and Limits

Modifier guidanceModifier | mixed

No codes listed

Annual session limit

Annual session limit (2022 and later)Up to 20 acupuncture sessions per calendar year for chronic low back pain.

Same-day servicesHumana treats all acupuncture services furnished the same day as if they were furnished in one session.

PCP exemption 2022–2025The 20-session limitation does not apply to services rendered by the patient’s primary care provider for 2022 through 2025.

PCP application in 2026For 2026, application of the 20-session limit to PCP‑rendered services varies by plan: Group MA plans — limit does not apply; Individual MA plans — limit applies.

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.

Definitions and Modifier Notes

Modifier KX

Modifier KX reporting for sessions 13–20Humana MA plans do not require providers to report modifier KX for acupuncture visits 13 through 20 in any calendar year, despite CMS guidance for Original Medicare.

Definition of Modifier KXModifier KX indicates requirements specified in the medical policy have been met.

Scope of guidanceThe policy statement about modifier KX applies specifically to billing for acupuncture for chronic low back pain under Humana MA plans for 2022 and later.