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. 🙂 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.