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).
No material clinical or coverage changes in this revision.
Coverage Criteria for Acupuncture
Coverage criteria for acupuncture for cLBP
Covered when ALL of the following are met:
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.
Coding, Modifiers, and Limits
| No codes listed |
Claims Submission and Provider Eligibility
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
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