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  • Is Acupuncture Covered by Insurance? IDC Codes and Billing

Is Acupuncture Covered by Insurance? ICD Codes and Insurance Billing

Did you know that in order to claim healthcare treatments on your insurance, an illness, injury, or medical procedure has to have a unique identifier – a “secret code” – that doctors and insurance companies use to communicate with one another? These unique codes were established by The World Health Organization (WHO) as the International Classification of Diseases (ICD) Codes, and are regularly updated to classify more and more injuries, diseases, and causes of death. These alphanumeric strings, though cryptic to the uninitiated, play a crucial role in ensuring smooth and accurate insurance billing. As of February 11, 2022, the eleventh revision, or ICD-11 came into effect, which includes more than 120,000 codable terms. Not only does it allow doctors and insurance companies to communicate, but it also ensures that health professionals around the world have standardized information for identifying health trends and statistics.

Acupuncture in the U.S.

Acupuncture is a form of Traditional Chinese Medicine that aims to promote health and well-being through the stimulation of specific points on the body known as acupoints. Typically, practitioners utilize ultra-thin, single-use needles inserted at these designated locations. This stimulates the body’s natural healing response, which in turn promotes physical and emotional well-being. According to Dominic P. Lu, DDS, LicAcu, and Gabriel P. Lu, MD, MA, PhD, “Acupuncture remained relatively unknown to the U.S. public until former President Nixon’s trip to China in 1972, where acupuncture as a potentially useful medical modality was noticed by the visiting people from the United States.” Since 1997, The National Institute of Health has formally endorsed acupuncture after mounting evidence from clinical trials for its value in relieving pain and treating conditions related to the nervous system, endocrine and immune systems, cardiovascular system, and digestive system. Since then, interest in acupuncture for its health benefits has increased in the U.S., with an estimated 20 million Americans having tried acupuncture, and the number of number of acupuncture procedures almost tripled between 2000 and 2010.

Acupuncture, Insurance, and ICD Codes

Today, many insurance companies in the U.S. cover acupuncture, depending on the specifics of your plan, the reason for seeking treatment, and the acupuncturist’s qualifications. Coverage is expected to increase further with the addition of acupuncture and other Traditional Chinese Medicine Modalities to the ICD codes with the release of ICD-11 in 2022. We spoke with Southern California University of Health Sciences (SCU) Eastern Medicine Department board member Marilyn Allen to learn more about the ICD codes and what it means for acupuncture to be included. Marilyn has served as a United States Delegate to WHO in the Traditional Medicine Reference Group, Education and Implementation Committee, and Patient Safety and Quality of Care Advisory Group. She was instrumental in the discussions to standardize 361 acupuncture points and a vocabulary list for WHO from 2005 to 2008 and again in 2010 as a United States Delegate to WHO. This lead to the inclusion of a set of acupuncture diagnostic codes in WHO ICD-11 Chapter 26, (TM) Traditional Medicine Coding of Chinese medical pattern differentiation. “I believe in this medicine from the soles of my feet to the tip of my head,” Marilyn says. “Because it has stood the test of time.” Marilyn asserts that she believes everyone should have the choice of what type of healthcare treatment they receive, whether that includes acupuncture or another form of traditional medicine. “I believe that [traditional medicine] should be at the beginning of healthcare,” Marilyn said. “We have a healthcare system in the U.S. that is very heroic at the end. Well, health is an issue that starts when you are born. And I also believe that everybody should have healthcare.” Part of Marilyn’s work in the Education and Implementation Committee is to teach the acupuncture codes and help the acupuncturists increase their communication with their patients, along with documentation. “Documentation is data,” Marilyn says. “Documentation is nothing more than thinking on paper.” By supporting the diagnostic codes with documentation, insurance companies and other groups will be able collect data to assist with billing. When WHO released ICD-10 in 1990, it took 22 years for the U.S. to adopt them. Now, Marilyn and others such as Jenny Yu, DACM, L.Ac., Dean, SCU Eastern Medicine Department, are part of the steering committee for the One Voice Big Evidence project, which has the goal to provide integration of ICD-11. In addition, Marilyn is also currently involved in work to get the term “acupuncturist” in Medicare. While the medicine itself is included, the term “acupuncturist” has yet to be added. The inclusion of acupuncture in ICD-11 is a big step for the acceptance and validation of acupuncture as a healthcare treatment worldwide. “There’s still a lot of work to do,” Marilyn says, “but I never thought we would make this much progress in my lifetime.” For more information on acupuncture and SCU’s Acupuncture and Chinese Herbal Medicine program, visit scuhs.edu/.

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