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. The are federally mandated plans and what is included comes from the federal level. We encourage you to contact your Reps and Senators asking them to include acupuncture in these plans that is allowed to be performed and billed by Licensed Acupuncturists.
Medicare recently started covering acupuncture for low back pain in 2020, but only MDs (and nurses and PAs working under them) that are also licensed acupuncturists can provide and bill Medicare for the service. Sadly, Licensed Acupuncturists are not included, yet perform the majority of acupuncture care in this country. Licensed acupuncturists at this time cannot bill Medicare for acupuncture. Your insurance customer service may tell you otherwise, but they overall unaware of this key detail. There is a new bill on the table changing the language to allow Licensed Acupuncturists to join Medicare and perform this service, but it has not been signed into law as of 2024. We will update with any changes if they occur.
Life Balance Acupuncture is an In-Network provider with UPMC.
Details and Requirements:
At this time, Medicare (UPMC for Life) and Medicaid (UPMC for You) plans are not covered. The are federally mandated plans and what is included comes from the federal level. We encourage you to contact your Reps and Senators asking them to include acupuncture in these plans that is allowed to be performed and billed by Licensed Acupuncturists.
Medicare recently started covering acupuncture for low back pain in 2020, but only MDs (and nurses and PAs working under them) that are also licensed acupuncturists can provide and bill Medicare for the service. Sadly, Licensed Acupuncturists are not included, yet perform the majority of acupuncture care in this country. Licensed acupuncturists at this time cannot bill Medicare for acupuncture. Your insurance customer service may tell you otherwise, but they overall unaware of this key detail. There is a new bill on the table changing the language to allow Licensed Acupuncturists to join Medicare and perform this service, but it has not been signed into law as of 2024. We will update with any changes if they occur.
Life Balance Acupuncture is 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
- 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 - Members must be 18 years or older to be eligible for treatment.
- Copays/Coinsurance/Deductibles vary from plan to plan. These 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.
Welcome Aetna Members
Starting on October 25, 2024, Life Balance Acupuncture will be an in-network provider with Aetna Insurance. Many commercial plans including HMOs and PPOs cover acupuncture for certain conditions. We will verify your acupuncture benefits with Aetna prior to your treatment as some plans only offer acupuncture for use as anesthesia done by an MD acupuncturist. No referral or doctor's order is required to use your Aetna acupuncture benefits. Number of covered visits vary based on progress and medical necessity as outlined by Aetna, but generally range from 10-20 covered treatments per insurance calendar year.
Licensed Acupuncturists are not yet included as providers for low back pain treatment offered by Medicare, so we cannot bill or accept Medicare until the law is changed. There is a proposed bill, but as of 2024, it has not yet been signed into law.
Covered Conditions:
Licensed Acupuncturists are not yet included as providers for low back pain treatment offered by Medicare, so we cannot bill or accept Medicare until the law is changed. There is a proposed bill, but as of 2024, it has not yet been signed into law.
Covered Conditions:
- Chronic (minimum 12 weeks duration) neck pain
- Chronic (minimum 12 weeks duration) headaches or migraines
- Low back pain
- Pain from osteoarthritis of the knee
- Pain from osteoarthritis of the hip
- Temporomandibular disorders (TMD)
- Nausea or vomiting during pregnancy
- Post-operative and chemotherapy-induced nausea and vomiting
- Post-operative dental pain
- Copays/Coinsurance/Deductibles vary from plan to plan. These must be paid at time of service and cannot be waived.
- If you exceed your number of covered visits, you must pay our regular fee out of pocket at time of service. Click HERE to see our services and fees. Click button below to schedule now!
Other Health Insurance Plans
If you have a non UPMC or Aetna 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.