Complementary and Alternative Medicine (CAM) Treatments for Behavioral and Substance Use Disorders

Coverage Summary (Part 2 — CAM interventions for behavioral health & SUD)

This policy part takes a mixed/investigational stance: a range of complementary and alternative medicine (CAM) modalities are listed as investigational for treating mental health and substance use disorders due to insufficient evidence. Coverage determinations are made in the context of member-specific benefit documents and applicable law, and Optum may use third-party tools to assist in benefit administration. The content is informational and intended to support professional judgment rather than prescribe care.

Investigational / Not Covered Criteria (behavioral health & SUD use)

Investigational / Not covered when used to treat behavioral health and substance use disorders

The following complementary and alternative medicine services are investigational for treating mental health and substance use disorders due to insufficient evidence:

Investigational CAM modalities

Acupuncture
Animal-Assisted Therapy
Art therapy
Brainspotting Therapy
Dance/movement Therapy
Equine Therapy
Music Therapy
Naturopathic detoxification
Reiki Therapy
Sauna/niacin detoxification (e.g., New Life Detox)

Coverage / Policy Position Summary (evidence & Medicare context)

Coverage / Policy Position Summary (Part 2 content)

This section summarizes evidence and Medicare/NCD positions for listed CAM modalities included in the policy part.

Coverage and evidence summary for CAM modalities

Medicare NCDs absent for listed CAM modalities: Medicare does not have National Coverage Determinations (NCDs) for: Animal-Assisted Therapy; Art therapy; Brainspotting Therapy; Dance/movement therapy (DMT); Equine therapy; Music therapy; Naturopathic detoxification; Reiki Therapy; Sauna/niacin detoxification (e.g., New Life Detox).
Acupuncture Medicare NCD: Medicare addresses acupuncture and covers only for chronic low back pain per NCDs (30.3 and subparts).
Evidence summaries indicate limited-quality evidence for some modalities: Evidence summaries indicate limited, low-to-moderate quality evidence for some modalities (e.g., music therapy shows small-to-moderate benefits in dementia and reductions in depression in older adults; equine-assisted services show potential benefits but limited by small studies; reiki meta-analysis shows anxiety reduction but heterogeneity and short-term data).

Coding (referenced codes for CAM modalities)

No procedure/coding guidance provided in this partmixed

No codes listed

Acupuncture codes (referenced; Medicare NCD applies for chronic low back pain only)CPT

97810	Acupuncture, 1 or more needles; without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient.
97811	Acupuncture, each additional 15 minutes, with re-insertion of needles(s). (List separately)
97813	Acupuncture, with electrical stimulation, initial 15 minutes of personal one-on-one contact.
97814	Acupuncture, with electrical stimulation, each additional 15 minutes, with re-insertion of needles(s). (List separately)

Unlisted psychiatric and activity therapy codes (referenced for CAM modalities)mixed

90899	Unlisted psychiatric service or procedure.
G0176	Activity therapy, such as music, dance, art or play therapies related to disabling mental health problems, per session (45 minutes or more).
H2032	Activity therapy, per 15 minutes.
S8940	Equestrian/hippotherapy, per session.

Procedure and diagnosis codes included in the policy are provided for reference only and do not by themselves indicate coverage or payment. Listing a code does not guarantee reimbursement; benefit coverage is determined by the member-specific plan and applicable law. Note: Medicare addresses acupuncture and limits coverage to chronic low back pain per NCD 30.3 series.

Provider Actions & Documentation / Billing Notes

Documentation Required

Confirm member eligibility and applicable benefit document

All reviewers must confirm the member’s eligibility and identify the member-specific benefit plan document and any applicable federal or state law(s) before using this policy to make coverage determinations.

Documentation Required

Defer to member-specific plan or law in case of conflict

If there is any conflict between this policy and the member-specific benefit document, the member-specific document governs; if that member-specific document conflicts with applicable law, the law governs.

Evidence Summaries & Definitions

The following section summarizes the available evidence for the CAM modalities addressed in this policy part. The evidence summaries describe the strength, limitations, and applicability of published studies and are provided for informational purposes to support clinical and coverage decision-making.

Evidence item	Summary
Acupuncture RCT (Hollifield et al. 2024)	Single RCT (n=93) verum acupuncture > sham for combat-related PTSD (between-group mean difference 7.1; P = .005); limitations include generalizability and durability.
Acupuncture systematic reviews/meta-analyses	Mixed evidence: some meta-analyses show benefit for sleep quality and depression severity; variable/low quality; possible dose-response with more sessions better.
Animal-Assisted Therapy systematic reviews (Pandey 2024, Rehn 2023, Chen 2022, Hediger 2021)	Preliminary positive findings across ASD, dementia, PTSD but studies small, heterogeneous, often low quality; limited durability and standardization.
Art Therapy systematic reviews	Some positive outcomes for ASD and cancer-related anxiety/depression and older adults with depression; evidence limited by small studies and heterogeneity.
Brainspotting (Horton 2023)	Nonrandomized controlled study (n=63) showed reduced depression and anxiety vs treatment-as-usual; small sample and variable clinician training.
Dance/movement Therapy systematic reviews/meta-analyses	Mixed results: some meta-analyses show no significant effects; others show reductions in depressive/anxiety/stress symptoms with methodological limitations.
Equine Therapy systematic reviews	Some improvements reported for ASD, PTSD, SUD, ADHD but many studies small, heterogeneous, limited durability; need rigorous trials.
Equine-assisted services for SUD (scoping review)	Some studies show increased treatment completion and retention but evidence limited by small samples and study quality.
Music therapy (Cochrane 2025)	Cochrane review in dementia: small beneficial effect for depressive symptoms (SMD -0.23); limited sustained effects beyond treatment.
Music therapy (Wang 2023)	Systematic review/meta-analysis in older adults with depression: SMD -1.40 favoring music therapy; low-moderate GRADE; high heterogeneity.
Music therapy for PTSD (Wang 2024)	Systematic review found passive music listening yielded most consistent benefits; studies small with limited long-term data.
Dance therapy (Christopher 2025; Karkou 2023)	Reviews/meta-analyses show mixed or minimal effects for stress/depression and dementia-related outcomes; low-certainty evidence and methodological limits.
Equine-assisted interventions for ASD (Xiao 2023)	Systematic review/meta-analysis (25 studies) suggests improvements in social and behavioral functioning but only 11 of 25 met high-quality standards; limited durability.
Equine therapy for veterans with PTSD (Li & Garcia 2023)	Systematic review (10 studies) reported symptom reductions and functional improvements but limited by small samples, lack of randomization/blinding, and limited durability data.
Reiki (Guo 2024)	Meta-analysis of 13 RCTs (n=824) showed anxiety reduction (SMD -0.82) with protocol variability and short-term follow-up; further research needed.
Naturopathic detoxification (KB220/NAAT and related)	Pilot and observational studies report improvements in abstinence/craving measures but are limited by small samples and nonrandomized designs; more rigorous trials needed.
Acupuncture for SUD (Hayes 2021; Krause 2020)	Reviews and RCTs show low-quality evidence with potential but unproven benefit; mixed trial results and methodological limitations.
Music therapy for SUD (Ghetti 2022 Cochrane)	Cochrane review: moderate reductions in craving and increased motivation as add-on to standard care; low-to-moderate confidence due to study limitations.
General evidence implication	Overall limited, low-to-moderate quality evidence across modalities; many studies small, heterogeneous, with short follow-up and inconsistent protocols.

Glossary — key terms used in this policy:

Complementary: a non-mainstream practice used together with conventional medicine.

Alternative: a non-mainstream practice used in place of conventional medicine.

Naturopathic detoxification: non–FDA-approved combinations of vitamins, minerals, amino acids, and/or NAD coenzymes administered IV and/or orally that claim to eliminate cravings.

Equine-assisted services (EAS): interventions involving horses, including horse-assisted therapy, equine-assisted physical therapy, and therapeutic riding.

CAM: Complementary and Alternative Medicine.

Medicare Determinations (NCD references)

Name	NCD Number	Type
Acupuncture	30.3	NCD
Acupuncture for Fibromyalgia	30.3.1	NCD
Acupuncture for Osteoarthritis	30.3.2	NCD
Acupuncture for Chronic Lower Back Pain	30.3.3	NCD

Revision History / Policy Updates

2025-06-16added

Added Brainspotting Therapy — Brainspotting content was added to the policy on 06/16/2025 (change.detail: Brainspotting Therapy content was added to the policy on 06/16/2025).

2025-06-16added

Added Reiki Therapy — Reiki content was added to the policy on 06/16/2025 (change.detail: Reiki Therapy content was added to the policy on 06/16/2025).

2025-06-16clarifiedLatest

Updated references/sourcing — Annual review updated references and sourcing; approved by Optum committees on 06/16/2025 and 07/22/2025 (change.detail: Annual review updated references and sourcing; approved 06/16/2025 and 07/22/2025).