Kaiser Insurance Acupuncture Coverage

Kaiser Insurance: What Conditions are Covered for Acupuncture Treatment?

Kaiser Insurance Acupuncture CoveragePhoto: Tanja Heffner

Kaiser Insurance on Acupuncture

You may have seen that Kaiser has taken over Group Health here in Washington. In their June 5, 2017 “Kaiser Permanente Washington Pre-Authorization Requirements” document, they¬†outline the conditions for which they have determined acupuncture treatment medically necessary. Any non-Medicare patient with Kaiser insurance coverage seeking over eight visits will have to meet the following criteria:

Conditions Covered

  • Arthritis, chronic
  • Dysmenorrhea (i.e. menstrual cramps)
  • Fibromyalgia (must incl. established, documented diagnosis of fibromyalgia)
  • Headaches, chronic
  • Myofascial pain, chronic, e.g.
    • cervicalgia
    • headaches, muscular-tension type
    • lumbago
    • neck and back pain, chronic
    • plantar fasciitis
    • thoracic outlet syndrome (TOS)
  • Nausea/vomiting due to pregnancy or chemotherapy
  • Neuropathic pain, chronic
  • “Other medical¬†medical conditions that have responded to an initial course of acupuncture with expectation of continued functional improvement.”
  • Pain (chronic) due to cancer
  • Pain flares “when acupuncture has provided clinical improvement in the past.”

Other Requirements

The condition has to result in functional limitation, i.e. you’re not able to do what you used to be able to do in your daily living, present daily, and persist beyond the typical time frame for untreated recovery. You’ll also need to document your baseline “measurable functional limitations” and show progress over treatment.

Is this list conclusive?

Of course not. ūüôā It’s subject to change, and is only a guideline. Each plan is different as well in the specifics of coverage and number of visits allowed.

Need Help?

Are you new to Kaiser insurance and would like Melissa to verify your acupuncture benefits prior to treatment? Feel free to reach out; she’d be happy to help you.

Acupuncture pain relief

Acupuncture Provides True Pain Relief in Study – NYTimes.com

“In conclusion, we found acupuncture to be superior to both no-acupuncture control and sham acupuncture for the treatment of chronic pain.”


Acupuncture Provides True Pain Relief in Study – NYTimes.com.

Meta-Analysis Cited

Acupuncture for Chronic Pain, Individual Patient Data Meta-analysis

Key Points

  • True acupuncture outperformed sham acupuncture and no-acupuncture controls in the treatment of chronic:
    • back pain
    • neck pain
    • osteoarthritis
    • headache
    • shoulder pain.
  • In studying 29 randomized controlled trials of roughly 1800 patients, researchers concluded that the¬†pain relief found from¬†acupuncture treatment is more than just placebo effect.
  • “Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option.”

Not all acupuncture is the same

Aiguille d acupuncture avec regle.dsc02265.untilted+cropped+WB Most people don’t know there are many different types of acupuncture: Traditional Chinese Medicine, Japanese, Korean, 5-Element, Classical, trigger point and more. The technique between these practices can be very, very different. Differences may include:

  • Number of needles:¬†Typically a practitioner will use no more than 8 in a treatment on the conservative end to over 30 in a single session.
  • Size of needles: On the finer end, a practitioner¬†might use a needle¬†.16mm in width, going up to about .30mm (still about a third the width of a sewing needle).
  • Needle retention: Needles can be left in for only¬†a matter of seconds, or¬†up to 45 minutes or longer.
  • Needle placement/location: Some practices will have preferences for distal points, local points, hands-only points, ear-only points, etc. Needle placement doesn’t have to be the same for two practitioners to both get great results from treatment.
  • Qi response: Some practitioners will want a strong “qi response” (think: zinger!) while others will just watch for changes in your breathing.

So, if you think you’ve tried acupuncture, I’d encourage you to consider the breadth of the practice. Don’t give up until you find the right match for you and your condition!

More on Acupuncture and Pain Relief