Welcome UPMC Members
Starting January 1, 2016, UPMC started offering acupuncture coverage for its commercial plans which include most PPO, HMO, and EPO plans. At this time, Medicare (UPMC for Life) and Medicaid (UPMC for You) plans are not covered. Medicare recently started covering acupuncture for low back pain, but only MDs that are also acupuncturists can provide and bill Medicare for the service. Licensed acupuncturists at this time cannot bill Medicare for acupuncture. We will update with any changes if they occur.
Life Balance Acupuncture is proud to be an In-Network provider with UPMC.
Details and Requirements:
Life Balance Acupuncture is proud to be an In-Network provider with UPMC.
Details and Requirements:
- Eligible members are covered for up to 12 acupuncture visits per benefit year.
- You must have a Physician's Order for acupuncture to use your UPMC coverage. (NOTE: UPMC customer service or your doctor's office may tell you that an order/referral is not required, but that is incorrect. The written UPMC Acupuncture Coverage Policy states a Physician's Order is required.)
- The Doctor's order should have the condition/code for that condition you are seeking care for.
- The doctor's office may fax the order to 855-296-7125 or bring it with you to your first appointment.
NOTE: Patients not using their coverage, those with non-UPMC plans, or those who pay cash for treatment do NOT require a doctor's order to receive care.
- UPMC covers acupuncture treatment for the following conditions:
- low back pain (lumbar)
- neck pain (cervicalgia)
- sciatica (lumbago/low back pain with sciatica)
- knee osteoarthritis
- migraines (Symptoms experienced for 15 days or more per month and lasting four hours a day or longer)
- nausea/vomiting (generally in pregnancy, patients on chemotherapy, following gastrointestinal surgery, but not limited to)
- Adverse effect of antineoplastic and immunosuppressive drugs
- NOTE: to ensure coverage follow these UPMC guidelines for coverage before seeking acupuncture care: For acupuncture treatment of migraine headaches, chronic pain in the lower back or neck or caused by knee osteoarthritis to be covered all of the following must exist and be documented: a. Diagnosis with supporting medical testing or evaluations b. Duration, intensity, and frequency of the pain c. Failure of standard treatments for a period of three months or more
- Please call or email if you have questions about covered conditions. This list is not exhaustive and covers only the most commonly treated conditions.
- Members must be 18 years or older to be eligible for treatment.
- Copays/Coinsurance vary from plan to plan. And must be paid at time of service and cannot be waived.
- If you exceed your 12 covered visits, you must pay our regular fee out of pocket at time of service. Click HERE to see our services and fees.
Other Health Insurance Plans
If you have a non UPMC plan that covers acupuncture, we will provide you with a superbill that you are responsible for turning into your insurance company for reimbursement. You must pay for the treatment at time of service. Please call your plan provider to check your acupuncture benefits and if there are any limitations to conditions covered to ensure your reimbursement.