Aetna · Clinical coverage policy

Aetna Acupuncture coverage criteria

Aetna covers acupuncture (manual or electroacupuncture) as medically necessary only for a defined set of indications: chronic neck pain or chronic headache (each at least 12 weeks), low back pain, nausea of pregnancy, osteoarthritis pain of the knee or hip (adjunctive), post-operative and chemotherapy-induced nausea/vomiting, post-operative dental pain, and temporomandibular disorders. Coverage is also subject to the member's actual plan benefit (some plans cover acupuncture only in lieu of anesthesia or only when given by a physician). Continued treatment requires meaningful symptom improvement (reevaluate after 4 weeks if no benefit); maintenance treatment and a large list of other indications (including dry needling and acupuncture point injection) are not covered as not medically necessary or experimental/investigational.

Policy CPB 0135 · Effective · Verify against the current Aetna policy before submitting — view source policy.

Payer

Aetna

Policy

CPB 0135

Prior auth

Confirm

Effective

January 1, 2026

This page reflects the coverage criteria captured from Aetna policy CPB 0135 and may not include every criterion, exception, or code — verify the complete bulletin before submitting.

What this means for the claim

The covered path, the next step to get it approved, and the specific way it denies — built only from this policy.

When does Aetna cover Acupuncture (CPT 97810), and what gets it denied?

Path
Aetna covers acupuncture (manual or electroacupuncture) as medically necessary only for a defined set of indications: chronic neck pain or chronic headache (each at least 12 weeks), low back pain, nausea of pregnancy, osteoarthritis pain of the knee or hip (adjunctive), post-operative and chemotherapy-induced nausea/vomiting, post-operative dental pain, and temporomandibular disorders. Coverage is also subject to the member's actual plan benefit (some plans cover acupuncture only in lieu of anesthesia or only when given by a physician). Continued treatment requires meaningful symptom improvement (reevaluate after 4 weeks if no benefit); maintenance treatment and a large list of other indications (including dry needling and acupuncture point injection) are not covered as not medically necessary or experimental/investigational. Coverage criteria include: Acupuncture (manual or electroacupuncture) is considered medically necessary for ANY ONE of the following indications; Chronic neck pain (minimum 12 weeks duration); Chronic headache (minimum 12 weeks duration); Low back pain; Nausea of pregnancy; Pain from osteoarthritis of the knee or hip (adjunctive / adjunctive therapy); Post-operative and chemotherapy-induced nausea and vomiting; Post-operative dental pain; Temporomandibular disorders (TMD); Continued/further acupuncture is medically necessary only if the member demonstrates meaningful improvement in symptoms; if no clinical benefit is appreciated after 4 weeks of acupuncture, the treatment plan should be reevaluated. Applies to 4 codes: 97810, 97811, 97813, 97814.
Action
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source.
Trap
Policy exclusions and limitations: Maintenance treatment, where the member's symptoms are neither regressing nor improving, is considered not medically necessary; Further acupuncture treatment is not considered medically necessary if the member does not demonstrate meaningful improvement in symptoms; Acupuncture is considered experimental and investigational / unproven for the following indications (all conditions below); Abdominal obesity; Acne; Acute pancreatitis; Addiction; AIDS; Alcohol withdrawal syndrome; Allergies; Alzheimer's disease; Amblyopia; Anorexia; Asthma; Attention deficit hyperactivity disorder (ADHD); Autism spectrum disorders; Bell's palsy; Benign prostatic hypertrophy; Breast cancer-related hot flashes; Breast cancer-related lymphedema; Burning mouth syndrome; Cancer-induced bone pain; Cancer-related dyspnea; Cancer-related fatigue; Cardiovascular diseases (angina pectoris, heart failure, hypertension); Carpal tunnel syndrome; Cerebral palsy; Chemotherapy-induced leukopenia; Chemotherapy-induced neuropathic pain; Chronic hepatitis B; Chronic ankle instability; Chronic pain syndrome (reflex sympathetic dystrophy [RSD], facial pain); Chronic obstructive pulmonary disease (COPD); Chronic constipation; Chronic fatigue syndrome; Cognitive impairment; Coronary heart disease; Diabetic gastroparesis; Diabetic peripheral neuropathy; Diminished ovarian reserve; Dry eyes; Dysmenorrhea; Endometriosis pain; Epilepsy; Erectile dysfunction; Facial spasm; Fetal breech presentation; Fibromyalgia; Fibrotic contractures; Gastric ulcer; Glaucoma; Gout; Hypoxic ischemic encephalopathy; Induction of labor; Infantile colic; Infantile diarrhea; Infertility (oocyte retrieval and embryo transfer during in-vitro fertilization [IVF]); Inflammatory bowel diseases (Crohn's disease and ulcerative colitis); Insomnia (including cancer-related insomnia); Intra-cerebral hemorrhage; Irritable bowel syndrome; Menopause-associated vasomotor symptoms; Menopausal hot flashes; Menstrual cramps / dysmenorrhea; Mild cognitive impairment; Multiple sclerosis; Mumps; Myofascial pain; Myopia; Neuropathic pain; Nocturnal enuresis; Non-alcoholic fatty liver disease; Obesity / weight reduction; Obstructive sleep apnea; Occipital neuralgia; Oligoasthenozoospermia; Oral ulcer; Osteoporosis; Painful neuropathies; Parkinson's disease; Parkinson's disease-related fatigue and depression; Peptic ulcer; Peripheral arterial disease (intermittent claudication); Phantom leg pain; Plantar fasciitis; Polycystic ovary syndrome; Post-herpetic neuralgia; Post-operative ileus; Post-prandial distress syndrome; Post-stroke hiccup; Post-stroke shoulder pain; Post-surgical neuropathic pain after breast cancer surgery; Post-traumatic stress disorder; Premature ejaculation; Premenstrual syndrome / premenstrual dysphoric disorder; Pruritus; Psoriasis; Psychiatric disorders (anxiety, depression, schizophrenia); Raynaud's disease pain; Renal colic; Respiratory disorders; Restless leg syndrome; Rheumatoid arthritis; Rhinitis; Sensorineural deafness; Sexual dysfunction; Shoulder bursitis; Sleep disturbance in individuals with cancer; Smoking cessation; Spasticity after stroke; Stroke rehabilitation (dysphagia); Systemic lupus erythematosus; Tennis elbow / epicondylitis; Thoracic back pain; Tic disorders (Tourette syndrome); Tinnitus; Urinary incontinence; Uterine fibroids; Vascular dementia; Xerostomia; Whiplash; Acupuncture point injection is considered experimental and investigational / unproven for the following indications (all conditions below); Acupuncture point injection for amyotrophic lateral sclerosis; Acupuncture point injection for cancer-related pain; Acupuncture point injection for cervical spondylosis; Acupuncture point injection for chronic daily headache; Acupuncture point injection for dysmenorrhea (menstrual pain); Acupuncture point injection for lateral elbow pain (tennis elbow); Acupotomy is considered experimental and investigational / unproven (including for herpes zoster, low back pain, shoulder pain, paresthesia of skin, and trigger finger); Dry needling is considered experimental and investigational / unproven; Transcutaneous electronic acupoint stimulation for post-operative recovery after gynecologic surgery is considered experimental and investigational / unproven; Teding Dianci Pu (TDP) lamp as an adjunct to acupuncture is considered experimental and investigational / unproven. Claims may be denied when the requested service falls under these.

Source: Aetna CPB 0135 — Acupuncture

Coverage criteria

  • Acupuncture (manual or electroacupuncture) is considered medically necessary for ANY ONE of the following indications
  • Chronic neck pain (minimum 12 weeks duration)
  • Chronic headache (minimum 12 weeks duration)
  • Low back pain
  • Nausea of pregnancy
  • Pain from osteoarthritis of the knee or hip (adjunctive / adjunctive therapy)
  • Post-operative and chemotherapy-induced nausea and vomiting
  • Post-operative dental pain
  • Temporomandibular disorders (TMD)
  • Continued/further acupuncture is medically necessary only if the member demonstrates meaningful improvement in symptoms; if no clinical benefit is appreciated after 4 weeks of acupuncture, the treatment plan should be reevaluated

Covered codes

Codes listed in this Aetna policy. Check each one's prior-authorization verdict and Medicare rate:

Frequently asked questions

When does Aetna cover Acupuncture (CPT 97810), and what gets it denied?
Aetna covers acupuncture (manual or electroacupuncture) as medically necessary only for a defined set of indications: chronic neck pain or chronic headache (each at least 12 weeks), low back pain, nausea of pregnancy, osteoarthritis pain of the knee or hip (adjunctive), post-operative and chemotherapy-induced nausea/vomiting, post-operative dental pain, and temporomandibular disorders. Coverage is also subject to the member's actual plan benefit (some plans cover acupuncture only in lieu of anesthesia or only when given by a physician). Continued treatment requires meaningful symptom improvement (reevaluate after 4 weeks if no benefit); maintenance treatment and a large list of other indications (including dry needling and acupuncture point injection) are not covered as not medically necessary or experimental/investigational. Coverage criteria include: Acupuncture (manual or electroacupuncture) is considered medically necessary for ANY ONE of the following indications; Chronic neck pain (minimum 12 weeks duration); Chronic headache (minimum 12 weeks duration); Low back pain; Nausea of pregnancy; Pain from osteoarthritis of the knee or hip (adjunctive / adjunctive therapy); Post-operative and chemotherapy-induced nausea and vomiting; Post-operative dental pain; Temporomandibular disorders (TMD); Continued/further acupuncture is medically necessary only if the member demonstrates meaningful improvement in symptoms; if no clinical benefit is appreciated after 4 weeks of acupuncture, the treatment plan should be reevaluated. Applies to 4 codes: 97810, 97811, 97813, 97814. Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. Policy exclusions and limitations: Maintenance treatment, where the member's symptoms are neither regressing nor improving, is considered not medically necessary; Further acupuncture treatment is not considered medically necessary if the member does not demonstrate meaningful improvement in symptoms; Acupuncture is considered experimental and investigational / unproven for the following indications (all conditions below); Abdominal obesity; Acne; Acute pancreatitis; Addiction; AIDS; Alcohol withdrawal syndrome; Allergies; Alzheimer's disease; Amblyopia; Anorexia; Asthma; Attention deficit hyperactivity disorder (ADHD); Autism spectrum disorders; Bell's palsy; Benign prostatic hypertrophy; Breast cancer-related hot flashes; Breast cancer-related lymphedema; Burning mouth syndrome; Cancer-induced bone pain; Cancer-related dyspnea; Cancer-related fatigue; Cardiovascular diseases (angina pectoris, heart failure, hypertension); Carpal tunnel syndrome; Cerebral palsy; Chemotherapy-induced leukopenia; Chemotherapy-induced neuropathic pain; Chronic hepatitis B; Chronic ankle instability; Chronic pain syndrome (reflex sympathetic dystrophy [RSD], facial pain); Chronic obstructive pulmonary disease (COPD); Chronic constipation; Chronic fatigue syndrome; Cognitive impairment; Coronary heart disease; Diabetic gastroparesis; Diabetic peripheral neuropathy; Diminished ovarian reserve; Dry eyes; Dysmenorrhea; Endometriosis pain; Epilepsy; Erectile dysfunction; Facial spasm; Fetal breech presentation; Fibromyalgia; Fibrotic contractures; Gastric ulcer; Glaucoma; Gout; Hypoxic ischemic encephalopathy; Induction of labor; Infantile colic; Infantile diarrhea; Infertility (oocyte retrieval and embryo transfer during in-vitro fertilization [IVF]); Inflammatory bowel diseases (Crohn's disease and ulcerative colitis); Insomnia (including cancer-related insomnia); Intra-cerebral hemorrhage; Irritable bowel syndrome; Menopause-associated vasomotor symptoms; Menopausal hot flashes; Menstrual cramps / dysmenorrhea; Mild cognitive impairment; Multiple sclerosis; Mumps; Myofascial pain; Myopia; Neuropathic pain; Nocturnal enuresis; Non-alcoholic fatty liver disease; Obesity / weight reduction; Obstructive sleep apnea; Occipital neuralgia; Oligoasthenozoospermia; Oral ulcer; Osteoporosis; Painful neuropathies; Parkinson's disease; Parkinson's disease-related fatigue and depression; Peptic ulcer; Peripheral arterial disease (intermittent claudication); Phantom leg pain; Plantar fasciitis; Polycystic ovary syndrome; Post-herpetic neuralgia; Post-operative ileus; Post-prandial distress syndrome; Post-stroke hiccup; Post-stroke shoulder pain; Post-surgical neuropathic pain after breast cancer surgery; Post-traumatic stress disorder; Premature ejaculation; Premenstrual syndrome / premenstrual dysphoric disorder; Pruritus; Psoriasis; Psychiatric disorders (anxiety, depression, schizophrenia); Raynaud's disease pain; Renal colic; Respiratory disorders; Restless leg syndrome; Rheumatoid arthritis; Rhinitis; Sensorineural deafness; Sexual dysfunction; Shoulder bursitis; Sleep disturbance in individuals with cancer; Smoking cessation; Spasticity after stroke; Stroke rehabilitation (dysphagia); Systemic lupus erythematosus; Tennis elbow / epicondylitis; Thoracic back pain; Tic disorders (Tourette syndrome); Tinnitus; Urinary incontinence; Uterine fibroids; Vascular dementia; Xerostomia; Whiplash; Acupuncture point injection is considered experimental and investigational / unproven for the following indications (all conditions below); Acupuncture point injection for amyotrophic lateral sclerosis; Acupuncture point injection for cancer-related pain; Acupuncture point injection for cervical spondylosis; Acupuncture point injection for chronic daily headache; Acupuncture point injection for dysmenorrhea (menstrual pain); Acupuncture point injection for lateral elbow pain (tennis elbow); Acupotomy is considered experimental and investigational / unproven (including for herpes zoster, low back pain, shoulder pain, paresthesia of skin, and trigger finger); Dry needling is considered experimental and investigational / unproven; Transcutaneous electronic acupoint stimulation for post-operative recovery after gynecologic surgery is considered experimental and investigational / unproven; Teding Dianci Pu (TDP) lamp as an adjunct to acupuncture is considered experimental and investigational / unproven. Claims may be denied when the requested service falls under these.
Does Aetna require prior authorization for Acupuncture?
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source.
What does Aetna exclude for Acupuncture?
Policy exclusions and limitations: Maintenance treatment, where the member's symptoms are neither regressing nor improving, is considered not medically necessary; Further acupuncture treatment is not considered medically necessary if the member does not demonstrate meaningful improvement in symptoms; Acupuncture is considered experimental and investigational / unproven for the following indications (all conditions below); Abdominal obesity; Acne; Acute pancreatitis; Addiction; AIDS; Alcohol withdrawal syndrome; Allergies; Alzheimer's disease; Amblyopia; Anorexia; Asthma; Attention deficit hyperactivity disorder (ADHD); Autism spectrum disorders; Bell's palsy; Benign prostatic hypertrophy; Breast cancer-related hot flashes; Breast cancer-related lymphedema; Burning mouth syndrome; Cancer-induced bone pain; Cancer-related dyspnea; Cancer-related fatigue; Cardiovascular diseases (angina pectoris, heart failure, hypertension); Carpal tunnel syndrome; Cerebral palsy; Chemotherapy-induced leukopenia; Chemotherapy-induced neuropathic pain; Chronic hepatitis B; Chronic ankle instability; Chronic pain syndrome (reflex sympathetic dystrophy [RSD], facial pain); Chronic obstructive pulmonary disease (COPD); Chronic constipation; Chronic fatigue syndrome; Cognitive impairment; Coronary heart disease; Diabetic gastroparesis; Diabetic peripheral neuropathy; Diminished ovarian reserve; Dry eyes; Dysmenorrhea; Endometriosis pain; Epilepsy; Erectile dysfunction; Facial spasm; Fetal breech presentation; Fibromyalgia; Fibrotic contractures; Gastric ulcer; Glaucoma; Gout; Hypoxic ischemic encephalopathy; Induction of labor; Infantile colic; Infantile diarrhea; Infertility (oocyte retrieval and embryo transfer during in-vitro fertilization [IVF]); Inflammatory bowel diseases (Crohn's disease and ulcerative colitis); Insomnia (including cancer-related insomnia); Intra-cerebral hemorrhage; Irritable bowel syndrome; Menopause-associated vasomotor symptoms; Menopausal hot flashes; Menstrual cramps / dysmenorrhea; Mild cognitive impairment; Multiple sclerosis; Mumps; Myofascial pain; Myopia; Neuropathic pain; Nocturnal enuresis; Non-alcoholic fatty liver disease; Obesity / weight reduction; Obstructive sleep apnea; Occipital neuralgia; Oligoasthenozoospermia; Oral ulcer; Osteoporosis; Painful neuropathies; Parkinson's disease; Parkinson's disease-related fatigue and depression; Peptic ulcer; Peripheral arterial disease (intermittent claudication); Phantom leg pain; Plantar fasciitis; Polycystic ovary syndrome; Post-herpetic neuralgia; Post-operative ileus; Post-prandial distress syndrome; Post-stroke hiccup; Post-stroke shoulder pain; Post-surgical neuropathic pain after breast cancer surgery; Post-traumatic stress disorder; Premature ejaculation; Premenstrual syndrome / premenstrual dysphoric disorder; Pruritus; Psoriasis; Psychiatric disorders (anxiety, depression, schizophrenia); Raynaud's disease pain; Renal colic; Respiratory disorders; Restless leg syndrome; Rheumatoid arthritis; Rhinitis; Sensorineural deafness; Sexual dysfunction; Shoulder bursitis; Sleep disturbance in individuals with cancer; Smoking cessation; Spasticity after stroke; Stroke rehabilitation (dysphagia); Systemic lupus erythematosus; Tennis elbow / epicondylitis; Thoracic back pain; Tic disorders (Tourette syndrome); Tinnitus; Urinary incontinence; Uterine fibroids; Vascular dementia; Xerostomia; Whiplash; Acupuncture point injection is considered experimental and investigational / unproven for the following indications (all conditions below); Acupuncture point injection for amyotrophic lateral sclerosis; Acupuncture point injection for cancer-related pain; Acupuncture point injection for cervical spondylosis; Acupuncture point injection for chronic daily headache; Acupuncture point injection for dysmenorrhea (menstrual pain); Acupuncture point injection for lateral elbow pain (tennis elbow); Acupotomy is considered experimental and investigational / unproven (including for herpes zoster, low back pain, shoulder pain, paresthesia of skin, and trigger finger); Dry needling is considered experimental and investigational / unproven; Transcutaneous electronic acupoint stimulation for post-operative recovery after gynecologic surgery is considered experimental and investigational / unproven; Teding Dianci Pu (TDP) lamp as an adjunct to acupuncture is considered experimental and investigational / unproven. Claims may be denied when the requested service falls under these.

Source

Aetna CPB 0135 — Acupuncture

Related

Need this Aetna approval drafted?

Ask D3 builds the documentation checklist and a ready-to-send request from this policy's criteria — cited, free, no signup.

Ask D3 Free

Coverage disclaimer

This page summarizes Aetna clinical-coverage criteria extracted from policy CPB 0135 for educational purposes. Coverage policies change and vary by individual plan. Always verify against Aetna's current policy before performing a procedure or submitting a claim. d3rx is not responsible for claim denials or reimbursement issues.