CurrentmhnPolicy N/A

Acupuncture and Chiropractic Coverage

Defines coverage, limits, and exclusions for acupuncture and chiropractic services available through Health Net in partnership with ASH Plans for members in the specified service area; affects members seeking those services and participating ASH network providers.

Policy Summary

Payermhn

PolicyAcupuncture and Chiropractic Coverage

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionNo referral is required to see an ASH Plans network-participating chiropractor or acupuncturist; consult the EOC for visit/cost variations.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

20max visits/yr

$20copay (variant)

$0copay (alt)

Coverage, Limits, and Exclusions

Covered Services and Conditions

Covered services and limits

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Covered conditions: Includes headache; back or neck pain; shoulder, hip, and knee joint pain; osteoarthritis and other arthritic pain; other joint and soft tissue pain; postoperative nausea and vomiting (PONV), pregnancy-associated nausea, chemotherapy-associated nausea; degenerative joint diseases/arthropathies; neurological conditions; inflammatory disorders; sprain/strain injuries to the spine and extremities; intervertebral disc injuries/disorders; muscular spasms and myalgias.

Nausea may require co-management with provider.

Excluded items include devices and personal/comfort items that are not integral to the delivery of acupuncture or chiropractic care. Examples specifically listed are therapeutic mattresses, air conditioners, air purifiers, and other comfort appliances.

Products normally considered durable medical equipment or supplies are excluded, including durable medical equipment, appliances, and items such as vitamins, minerals, and nutritional supplements.

Diagnostic and imaging technologies are not covered under these programs: diagnostic scanning including MRI, CT scans, and thermography are explicitly excluded.

Services or supplies explicitly listed as not covered under the acupuncture or chiropractic care programs may instead be considered under the plan's medical benefits. Providers and members should consult the member's Evidence of Coverage (EOC) for details on whether excluded items might be covered elsewhere in the plan.

The policy makes clear that exams and treatments that are not intended for neuromusculoskeletal disorders, pain, nausea, or other conditions described as covered will not be covered under the acupuncture or chiropractic programs; those items may require evaluation under the medical benefits portion of the plan.

Provider Requirements, Referrals, and Authorization

Prior Authorization

Referrals and authorization

No referral is required to see an ASH Plans network-participating chiropractor or acupuncturist; members may directly select a participating provider. Consult the member's Evidence of Coverage (EOC) for plan-specific visit limits, copay differences, and any Medicare-covered service limits that may apply.

Step Therapy

Step therapy not specified

This policy does not specify any step therapy requirements for acupuncture or chiropractic services. Providers and members should refer to the plan's EOC for any plan-specific utilization management rules.

Documentation Required

Consult EOC and contact Health Net

Members and providers should consult the plan's Evidence of Coverage (EOC) for details on coverage, copayment and visit variations, and Medicare-specific limits; contact Health Net Member Services for additional information.

Health Net Member Services: 1-800-275-4737 (TTY: 711)
Office hours Oct 1–Mar 31: daily 8 a.m.–8 p.m.; Apr 1–Sep 30: Mon–Fri 8 a.m.–8 p.m.; messaging after hours/weekends/holidays.

Denial Risk

Denial risk — excluded services and items

Services or supplies that fall under the policy's listed limitations and exclusions may be denied; verify coverage before providing or billing for excluded items.

Diagnostic scanning (MRI, CT) and thermography are excluded.
Devices, durable medical equipment, appliances, therapeutic mattresses, air conditioners/purifiers, vitamins/minerals/nutritional supplements, and comfort items are excluded.
Exams and treatments unrelated to neuromusculoskeletal disorders are excluded; such services may instead be considered under the plan's medical benefits per the EOC.

Excluded Items and Definitions

Excluded services and devices

Diagnostic imaging (MRI, CT) and thermographyExcluded from coverage under the acupuncture and chiropractic programs.

Devices and durable medical equipmentIncludes devices, durable medical equipment, appliances, and similar items; not covered.

Personal and comfort itemsAir conditioners, air purifiers, therapeutic mattresses, and other comfort items are excluded.

Vitamins, minerals, and nutritional supplementsVitamins, minerals, and nutritional supplements are not covered under these programs.

Exams and treatments unrelated to neuromusculoskeletal disordersServices or exams not intended for musculoskeletal/related disorders, pain, nausea, or other covered conditions are excluded.

Background and Scope

Acupuncture and chiropractic services are offered to treat a range of musculoskeletal and related disorders and symptoms including headache, back and neck pain, joint pain (shoulder, hip, knee), osteoarthritis and other arthritic pain, soft tissue pain, sprain/strain injuries, intervertebral disc disorders, muscular spasms and myalgias, and certain neurological and inflammatory conditions.

These services are also covered for management of nausea in specific contexts, including postoperative nausea and vomiting (PONV), pregnancy-associated nausea, and chemotherapy-associated nausea. Coverage focuses on treatments related to neuromusculoskeletal conditions and related symptoms and may require co-management with the member's treating provider.