Accepting Acupuncture Coverage for UPMC Members

On January 1, 2016, UPMC started offering acupuncture coverage for its commercial plans which include most PPO, HMO, and EPO plans. At this time, Medicare plans are not covered. 

​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 is not required, but they may not be yet aware of the change.)
  • The Doctor's order should have the condition/code for that condition you are seeking care for.
  • It's easy! The doctor's office may fax the order to 855-296-7125 or bring it with you to your first appointment. Generally no doctor visit required, just a phone call!
     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:
  • ​back pain (lumbar, thoracic)
  • neck pain/ spondylolysis in the neck 
  • sciatica/radiculopathy (pinched nerve causing pain)
  • knee osteoarthritis 
  • migraines (Symptoms experienced for 15 days or more per month and lasting four hours a day or longer) 
  • Sacroiliac Joint (SI) Sprain/ Sacrococcygeal disorders (sacrum/coccyx)
  • nausea/vomiting (generally in pregnancy, patients on chemotherapy, following gastrointestinal surgery, but not limited to)
  • 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.

Members can call UPMC to check their eligibility and benefits at 1-888-876-2756 or call their UPMC Healthcare Concierge before scheduling. Click below to schedule!

Feel free to email us with any questions. 

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