“Is Acupuncture Covered by Health Insurance?”

© 2020 by Dr. David B. Meredith, D.Ac.

Continuing my series of answers to common questions about acupuncture treatment is the one my assistants get daily: Is acupuncture therapy covered by my health insurance? 

Note that some of the details here focused on Maryland and some of the large insurers in this state, although a few have to do with insurance coverage in general. The coverage in every health insurance plan are highly individual, so please contact your administrator for the most complete information about your own coverage.

Around a decade ago, more health insurance plans started covering acupuncture. In Maryland, this had something to do with proposed "model" plans that featured acupuncture as a manual therapy as a way to satisfy the requirements of the Affordable Care Act. However, some of the "legacy" types of coverage also continued to exist at the same time. For example, there was something called "acupuncture in lieu of anesthesia" which only covered procedures performed by physicians in a surgical setting. (This kind of outdated coverage largely exists today in certain self-funded insurance plans from large organizations.)

Today, many plans have coverage when acupuncture is performed by a licensed acupuncturist, but there are other potential limitations. Some plans only cover a certain number of visits per year, or some limit the diagnosis codes that will be reimbursed. The most common acceptable codes are for lower back pain or headaches. 

Medicare has famously begun the practice of covering acupuncture, only for low back pain, only when performed by a physician. The American Society of Acupuncturists has been working on the process for getting coverage for procedures performed by licensed acupuncturists, but that is a complicated process. In the meantime, the Veterans Association has been covering acupuncture for any number of conditions, as performed by licensed acupuncturists for many years.

The last consideration is whether the acupuncturist is in- or out-of-network with any given plan. Some plans only cover in-network providers, some will cover out-of-network but sometimes for a higher copay or deductible. Sometimes there is a process that involves the acupuncturist collecting payment, providing a statement to you, and you having to to apply for reimbursement from the insurance company itself. 

At Very Well, we try to make this tricky process navigable by checking your benefits before your first appointment, but it usually behooves you as a consumer to understand your relationship with your insurance company and what you can expect from them.