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Acupuncture Services

Revised: 02-25-2016

Overview

This section provides policy and billing information for acupuncture service provided by eligible providers.

The Practice of Acupuncture
The practice of acupuncture means a comprehensive system of health care using Oriental medical therapy, including the insertion of acupuncture needles through the skin, and its unique methods of diagnosis and treatment.

Eligible Providers

The following licensed practitioners may provide acupuncture:

  • • Acupuncturists
  • • Chiropractors who have complied with the Minnesota Board of Chiropractic Examiners acupuncture registration requirements
  • • Osteopaths
  • • Physicians
  • Enrollment Requirements

    Effective January 1, 2012, the following enrollment requirements apply for acupuncturists and chiropractors:

    Acupuncturists

  • • A person is eligible to enroll as an acupuncturist if he or she holds a license to engage in the practice of acupuncture from the Minnesota Department of Health.
  • • Acupuncturists practicing outside Minnesota must comply with the licensure requirements of the state in which they practice.
  • Chiropractors

  • • Chiropractors must have complied with the Minnesota Board of Chiropractic Examiners (MBCE) acupuncture registration requirements.
  • • Current MHCP enrolled chiropractors must provide a copy of the MBCE acupuncture registration to Provider Enrollment
  • • Claims submitted for acupuncture services will deny if Provider Enrollment has not received the MBCE registration.
  • • Chiropractors practicing chiropractic medicine outside Minnesota must comply with the acupuncture licensure and registration requirements in the state in which they practice.
  • Refer to Provider Basics of the MHCP Provider Manual for more information on the Provider Requirements and the Enrollment Process.

    Eligible Recipients

    Recipients of the following may receive acupuncture services:

  • • Medical Assistance (MA)
  • • MinnesotaCare
  • Covered Services

    Acupuncture is covered only when provided by a licensed acupuncturist or by another Minnesota licensed practitioner for whom acupuncture is within the practitioner's scope of practice and who has specific acupuncture training or credentialing.

    Acupuncture is covered for the following conditions:

  • • Acute pain
  • • Chronic pain
  • • Depression
  • • Anxiety
  • • Schizophrenia
  • • Post-traumatic stress disorder
  • • Insomnia
  • • Smoking cessation
  • • Restless legs syndrome
  • • Menstrual disorders
  • • Xerostomia (dry mouth) associated with:
  • • Sjogren’s syndrome
  • • Radiation therapy
  • • Nausea and vomiting associated with:
  • • Post-operative procedures
  • • Pregnancy
  • • Cancer care
  • Items that fall within an acupuncturist scope of practice such as, breathing techniques, dietary guidelines and exercise based on Oriental principles are considered part of an acupuncturist’s visit and are not reimbursed separately.

    MHCP allows up to 20 units of acupuncture services annually without authorization. Request authorization if additional units are needed.

    Prior to the start of acupuncture treatment, a comprehensive history and physical evaluation of the patient is required to document the cause or origin of the condition being treated. The provider must document this comprehensive history in the patient’s record.

    MHCP does not cover maintenance treatment where symptoms are not regressing or not showing improvement. Acupuncture treatment is not considered medically necessary if the recipient does not show improvement in symptoms.

    Noncovered Services

    Acupuncture is not covered for the following conditions: (This is not an all-inclusive list of conditions for which acupuncture is not covered.)

  • • Weight loss
  • • Drug or alcohol dependence
  • • Infertility
  • • Fatigue
  • • Allergies or asthma
  • • Acne
  • • Nausea due to conditions other than surgery, pregnancy or cancer care
  • • High blood pressure
  • • Cold or influenza
  • • Sexual dysfunction
  • Other types of Oriental medicine are not covered. MHCP does not cover the following: (This is not an all-inclusive list of noncovered Oriental medicine services.)
  • • Acupressure
  • • Massage
  • • Herbal supplements
  • Authorization Requirements

    To request an authorization, use the MHCP MN–ITS Interactive User Guide (PDF) to login to MN–ITS and submit a MN–ITS Interactive Authorization Request or, submit the Medical Authorization form (DHS-4695) (PDF) to the authorization medical review agent.

    Authorization Criteria

    Documentation must include the following:

  • • The diagnosis for the cause/origin of the symptom being treated
  • • Evidence that the patient is responding favorably to the acupuncture treatment and that further improvement is expected with additional treatment
  • • The acupuncture technique being requested
  • • A comprehensive history and physical evaluation of the patient
  • • Plan of care for the acupuncture treatment
  • • Other treatments the patient is receiving for the diagnosis, regardless of where or by whom they are being treated. Examples of other treatment may include opioids, physical therapy and medical cannabis.
  • • When applicable, provide documentation that favorable outcomes from acupuncture treatments have reduced the patient’s need for opioids or led to improved utilization of other treatment modalities.
  • Billing

    Use MN–ITS 837P Professional. Refer to the MN–ITS User Guide for claim completion instructions.

    Diagnosis Codes
    Providers are required to indicate the most applicable ICD diagnosis codes when billing acupuncture services.

    Acupuncture Codes

    Codes

    Description

    97810

    Acupuncture, 1 or more needles; without electrical stimulation, initial 15 minutes of personal one-to-one contact with patient

    97811

    Without electrical stimulation, each additional 15 minute of personal one-to-one contact with patient, with re-insertion of needle(s) (List separately in addition to code for primary procedure)

    97813

    With electrical stimulation, initial 15 minutes of personal one-to-one contact with the patient

    97814

    With electrical stimulation, each additional 15 minutes of personal one-to-one contact with the patient, with re-insertion of needles(s) (List separately in addition to code for primary procedure)

    Definitions

    Acupuncture Practice
    "Acupuncture practice" means a comprehensive system of health care using Oriental medical theory and its unique methods of diagnosis and treatment. Treatment techniques include the insertion of acupuncture needles through the skin and use of other biophysical methods of acupuncture point stimulation, including the use of heat, Oriental massage techniques, electrical stimulation, herbal supplemental therapies, dietary guidelines, breathing techniques, and exercise based on Oriental medical principles.

    Legal References

    Minnesota Statutes 256B.0625, subd. 8f, Covered Services
    Minnesota Statutes 147B.01
    Definitions, Subd.3
    Minnesota Statutes 147B.02
    Licensure
    Minnesota Rules 9505.0195
    Provider Participation
    Minnesota Rules 9505.0205
    Provider Records

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