CurrentHumanaPolicy CP2O21OO1

Acupuncture for Chronic Lower Back Pain

Humana Medicare Advantage (MA) payment policy for acupuncture services for chronic lower back pain (cLBP), describing practitioner eligibility, session limits, and billing guidance for providers treating Humana MA members.

Policy Summary

PayerHumana

PolicyAcupuncture for Chronic Lower Back Pain

Policy CodePolicy CP2O21OO1

Change TypeNo material changes

Effective Date2022-01-01 or as written

Next Review Date

Key ActionSubmit claims that meet medical necessity and applicable referral/authorization requirements and ensure practitioner licensure and plan participation are satisfied.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

20max sessions/year

2022+applies from

2022-2025PCP exemption

Acupuncture for Chronic Lower Back Pain — Coverage Criteria

Acupuncture for cLBP coverage criteria

Humana MA plans cover acupuncture for chronic lower back pain (cLBP) consistent with Original Medicare diagnoses and applicable CMS guidance, with the following plan-specific provisions.

Coverage aligns with Original Medicare diagnoses for acupuncture for cLBP and follows applicable CMS transmittals and Internet‑only Manuals for the date of service.

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

Practitioner eligibility: 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 for acupuncture for cLBP (coverage is not limited to only those practitioner types that can bill Original Medicare).

ALL of the following

Policy Summary

PayerHumana

PolicyAcupuncture for Chronic Lower Back Pain

Policy CodePolicy CP2O21OO1

Change TypeNo material changes

Effective Date2022-01-01 or as written

Next Review Date

Key ActionSubmit claims that meet medical necessity and applicable referral/authorization requirements and ensure practitioner licensure and plan participation are satisfied.

SourceLink

On This Page

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Authorization, Documentation, and Plan Requirements

Prior Authorization

Authorization and plan requirements

Claims payments are subject to plan requirements including medical necessity, reasonableness, and applicable referral or authorization requirements. Providers must report acupuncture for cLBP services consistent with applicable CMS transmittals and manuals, and payment is contingent on meeting those plan and coverage requirements.

Payment is conditional on medical necessity and reasonableness.
Applicable referral or authorization requirements must be met for claim processing.
Submit claims in accordance with applicable CMS transmittals and Internet‑only Manuals for the date of service.

OpenPayer

Acupuncture for Chronic Lower Back Pain

Acupuncture for Chronic Lower Back Pain — Coverage Criteria

Billing, Modifiers, and Session Limits

Authorization, Documentation, and Plan Requirements

Key Definitions