Acupuncture for Chronic Lower Back Pain
Billing requirements and reimbursement guidelines for Humana Medicare Advantage plans providing acupuncture for chronic lower back pain; replaces or augments Original Medicare guidance for MA plan processing and applies to providers submitting claims to Humana MA plans.
For dates of service on or after January 1, 2022, Humana MA plans permit additional practitioner types (beyond those allowed under Original Medicare) to submit claims if they satisfy applicable licensure and plan requirements.
For 2022 and later, Humana MA plans cover up to 20 acupuncture sessions per year and do not require modifier KX for sessions 13–20.
The 20-session per year limit does not apply to services rendered by the patient's PCP for 2022–2025; applicability in 2026 varies by Humana MA plan type.
Coverage Criteria — Acupuncture for Chronic Lower Back Pain
Coverage criteria for acupuncture for cLBP
Covered with criteria — Humana Medicare Advantage (MA) plans cover acupuncture for chronic lower back pain (cLBP) when the diagnosis and services meet medical necessity and plan requirements, subject to the rules below.
Coding and Session Limits
| KX | Requirements specified in the medical policy have been met. |
| KX (not required for sessions 13–20) | For 2022 and later, Humana MA plans cover up to 20 acupuncture sessions per year and do not require providers to report modifier KX for acupuncture visits 13 through 20 in any calendar year (despite CMS guidance for Original Medicare). |
Authorization, Claims, and Billing Requirements
Authorization, documentation, and claim reporting requirements
Claims for acupuncture for chronic low back pain must meet all Humana MA plan processing requirements — including medical necessity, reasonableness, and any applicable referral or authorization rules — and providers must report services consistent with applicable CMS transmittals and Internet‑only Manuals unless Humana notes an exception. Failure to meet plan authorization or documentation requirements may result in claim denial or payment adjustment.
- Follow applicable referral or authorization rules before furnishing services when required by the member’s plan.
- Document medical necessity and reasonableness in the medical record and include supporting information on the claim.
- Report acupuncture for cLBP services consistent with CMS transmittals and Internet‑only Manuals for the date of service unless Humana explicitly states an exception.
Key Definitions
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