Acupuncture Services

Revised: July 12, 2022

· Eligible Providers

· Eligible Members

· Covered Services

· Noncovered Services

· Noncovered Conditions

· Authorization Requirements

· Billing

· Legal References

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

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 comply with the Minnesota Board of Chiropractic Examiners (MBCE) acupuncture registration requirements and provide a copy of the MBCE acupuncture registration to Minnesota Health Care Programs (MHCP).

· Claims submitted for acupuncture services will deny if MHCP 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 the Provider Basics section of the MHCP Provider Manual for more information on provider requirements and the enrollment process.

Eligible Members

Members eligible for Medical Assistance (MA) and MinnesotaCare may receive acupuncture services.

Covered Services

MHCP covers acupuncture 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.

MHCP covers acupuncture 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

Other items that fall within an acupuncturist scope of practice that are based on Traditional Chinese Medicine are considered part of an acupuncturist’s visit and are not reimbursed separately by MHCP.

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

Before the start of acupuncture treatment, the acupuncture provider must document a brief history of the patient’s presenting problem. The medical record must also include the acupuncture provider’s documentation of a limited exam of the condition the provider treated or the affected body area.

MHCP does not cover maintenance treatment where symptoms are not regressing or not showing improvement. MHCP does not consider acupuncture treatment medically necessary if the member does not show improvement in symptoms.

Noncovered Services

· MHCP does not reimburse the following services separately: (This list is not an all-inclusive.)

· Acupressure

· Massage

· Herbal supplements

· Dietary guidelines

· Breathing techniques

· Use of heat

· Exercise

Noncovered Conditions

MHCP does not cover acupuncture for the following conditions: (This list is not all-inclusive.)

· 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

Authorization Requirements

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

Authorization Criteria

Documentation must include the following:

· The diagnosis for the cause or 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 MHCP MN–ITS 837P Professional User Guides for claim instructions.

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

Acupuncture Codes

Codes	Description
97810	Acupuncture, initial 15 minutes
97811	Acupuncture, each additional 15 minutes (List separately in addition to code for primary procedure)
97813	Acupuncture with electrical stimulation, initial 15 minutes
97814	Acupuncture with electrical stimulation, each additional 15 minutes (List separately in addition to code for primary procedure)

Legal References

Minnesota Statutes 256B.0625, subdivision 8f (Acupuncture services)
Minnesota Statutes 147B.01, subdivision 3 (Acupuncture practice)
Minnesota Statutes 147B.02 (Licensure)
Minnesota Rules 9505.0195 (Provider Participation)
Minnesota Rules 9505.0205 (Provider Records)