Restored acupuncture services as a covered benefit under the MediCal program
| Date: | July 25, 2016 |
| To: | To: Health Plan of San Joaquin (HPSJ) Providers |
| From: | HPSJ Provider Services Department |
| Subject: | Acupuncture |
| Business: | Medi-Cal, AIM (now known as Medi-Cal Access Program) |
Effective July 1, 2016
California Assembly Bill AB 833 restored acupuncture services as a covered benefit under the MediCal program, Medi-Cal Managed Care Plans, and Cal Medi-Connect plans.
Clarification regarding the reinstatement of this benefit follows.
Program Coverage
Acupuncture services are only reimbursable using CPT-4 procedure codes 97810, 97811, 97813, 97814 when –
- Rendered by a contracted physician, dentist, podiatrist or certified acupuncturist enrolled in the Medi-Cal program and who is eligible to provide Medi-Cal services.
- Limited to treatment performed to prevent, modify or alleviate the perception of severe, persistent chronic pain resulting from a generally recognized medical condition.
- Used with or without electric stimulation of the needles.
- Used to treat a condition also covered by other modalities.
- Limited to a maximum of two services per calendar month (CCR, Title 22, Section 51304[a]).
Eligibility Requirements
Providers should verify the recipient’s Medi-Cal eligibility for the month of service.
Authorization
Authorization is not required for acupuncture services.
Non-Covered Services
Acupuncture services are not reimbursable when –
- Billed as an emergency or inpatient service.
- Rendered by a physician assistant, nurse practitioner or certified nurse midwife.
Non-acupuncture services rendered by a certified acupuncturist are not reimbursable. In addition, if the only service rendered is an acupuncture treatment, physicians and podiatrists may not be reimbursed for an office or medical visit.
Billing Acupuncture Services
https://files.medi-cal.ca.gov/pubsdoco/newsroom/newsroom_24981.asp
If you have any further questions, please contact our Provider Services Department at 209-942-6340.