CurrentNeighborhood Health Plan of Rhode IslandPolicy N/A

Complementary and Alternative Medicine (CAM) — Acupuncture payment policy

Defines coverage, limitations, coding and billing rules for acupuncture services for Neighborhood Health Plan of Rhode Island Medicaid line of business (excluding Extended Family Planning). Applies to providers billing Medicaid members of this plan.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyComplementary and Alternative Medicine (CAM) — Acupuncture payment policy

Policy CodePolicy N/A

Change TypeRevisions and removals (template updatechiropractic removalexclusions updated)

Effective Date07/01/2018

Next Review DateN/A

Key ActionVerify member eligibility, coverage and authorization criteria prior to rendering acupuncture services.

SourceLink

POLICY UPDATE CHANGES

01/01/2026: Updated policy template to include new lines of business and updated Member Responsibility and Disclaimer language.

11/07/2025: Removed chiropractic benefit.

12/11/2024: Updated acupuncture and chiropractic exclusions/limitations.

03/11/2024 and 01/01/2023: Annual policy review dates with no content changes.

12acupuncture visit limit per rolling year

4approved acupuncture CPT codes listed

3diagnoses for which acupuncture is covered

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When Acupuncture Is Covered

Coverage criteria for acupuncture

Acupuncture is covered only when all criteria below are met.

ALL of the following

Member is enrolled in Neighborhood Health Plan of Rhode Island Medicaid (excluding EFP).
Service is acupuncture performed in an office setting (not in home, nursing, residential, domiciliary, or custodial facilities).
Diagnosis is one of: chronic low back pain, fibromyalgia, or chronic migraine.
Total acupuncture services do not exceed 12 visits per rolling year.>= 0
Acupuncture provided by licensed acupuncturists using approved CPT codes (97810, 97811, 97813, 97814).

Thresholds and limits

Visit limit12 visits per rolling year

Covered diagnosesChronic low back pain; Fibromyalgia; Chronic migraine

Place-of-service restrictionOffice settings only; not covered in home, nursing, residential, domiciliary, or custodial facilities

Approved CPT Codes for Acupuncture

Approved acupuncture CPT codes (licensed acupuncturists)CPTCovered

97810	Acupuncture, 1 or more needles; without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
97811	Acupuncture, 1 or more needles; without electrical stimulation, each additional 15 minutes (list separately in addition to primary procedure)
97813	Acupuncture, 1 or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
97814	Acupuncture, 1 or more needles; with electrical stimulation, each additional 15 minutes (list separately in addition to primary procedure)

What Is Not Covered / Limitations

Massage therapy services are excluded from coverage.

Any service not specifically listed as covered is excluded.

Acupuncture performed in home, nursing, residential, domiciliary, or custodial facilities is not covered.

Acupuncture assistants are not separately reimbursed.

Billing & Documentation Requirements for Providers

Documentation Required

Verify eligibility and coverage

Provider must verify member eligibility, coverage and authorization criteria prior to rendering services.

Billing Rule

Place-of-service restriction

Acupuncture is covered only when performed in office settings; services performed in home, nursing, residential, domiciliary, or custodial facilities are not covered.

Billing Rule

Assistant billing

Acupuncture assistants will not be separately reimbursed.

Billing Rule

Timely filing

Submit complete claims for payment within contractually determined timely filing guidelines; claims are subject to plan edits and provider contract rules.

Policy Scope and Context

This policy defines coverage, limitations, coding and billing rules for acupuncture services for Neighborhood Health Plan of Rhode Island Medicaid line of business, excluding Extended Family Planning (EFP). It applies to providers billing Medicaid members of this plan and specifies applicable place-of-service restrictions, diagnoses for coverage, visit limits, and approved procedure codes.

Acupuncture services are covered only under defined criteria: services must be provided in an office setting, be performed for one of the covered diagnoses (chronic low back pain, fibromyalgia, or chronic migraine), not exceed 12 visits per rolling year, and be provided by licensed acupuncturists using the approved CPT codes. Providers must verify member eligibility, coverage, and any authorization requirements prior to rendering services.

This payment policy is specific to the Medicaid line of business (excluding EFP). For information about acupuncture reimbursement under the Commercial line of business, refer to the separate Acupuncture Service Payment Policy referenced in this document.

Document history notes administrative and content changes, including template and disclaimer updates on 01/01/2026 and prior substantive updates to acupuncture exclusions and limitations on 12/11/2024.

Policy Updates

2026-01-01Administrative/template updateLatest

Updated policy template to include new lines of business and updated Member Responsibility and Disclaimer language.

2025-11-07Removed benefit (material)

Removed chiropractic benefit referenced in the document.

2024-12-11Exclusions/limitations updated (material)

Updated acupuncture and chiropractic exclusions and limitations.

2024-03-11Annual review (no content changes)

Annual policy review date with no content changes.

2023-01-01Annual review (no content changes)

Annual policy review date with no content changes.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyComplementary and Alternative Medicine (CAM) — Acupuncture payment policy

Policy CodePolicy N/A

Change TypeRevisions and removals (template updatechiropractic removalexclusions updated)

Effective Date07/01/2018

Next Review DateN/A

Key ActionVerify member eligibility, coverage and authorization criteria prior to rendering acupuncture services.

SourceLink

On This Page

OpenPayer

Complementary and Alternative Medicine (CAM) — Acupuncture payment policy

When Acupuncture Is Covered

Approved CPT Codes for Acupuncture

What Is Not Covered / Limitations

Billing & Documentation Requirements for Providers

Policy Scope and Context

Defined Terms

Policy Updates