MassHealth and Acupuncture

— UPDATE – April 24, 2015: Please see my new post on how to be covered with MassHealth.  —

Since the beginning of this year, there are some change to the health care rules and regulations. Overall, I would say the change is good even tho it created some chaos during the sign up process. Over the past few months, I have discovered that MassHealth now covers acupuncture treatment for pain, but the details aren’t clear.

I am willing to accept MassHealth patients and do all the paperwork, but since I am still out-of-network provider for most MassHealth health plans, you might need to wait 1 week to get authorization for the treatment.

I Google “MassHeath acupuncture” and found a post by Andrew Levine from Donoghue Barrett & Singal law firm. Here is what he said about MassHealth and acupuncture.

MassHealth members are eligible to receive acupuncture for treatment of pain.

MassHealth previously covered acupuncture for substance abuse detox and acupuncture as a substitution for surgical anesthetic, but did not cover acupuncture for the general treatment of pain. The AOH, CHC and PHY program regulation manuals now add provisions for such coverage. Each of these manuals contain a definition for acupuncture and terms for provider qualifications and claims submission.

MassHealth provides a total of 20 sessions of acupuncture for treatment of pain per member per year without prior authorization. If the member’s condition, treatment, or diagnosis changes, the member may receive more sessions of medically necessary acupuncture treatment with prior authorization. Qualified providers are physicians and other providers licensed by the board of Registration in Medicine (“BoRM”) under 243 CMR 5.00. For claims to be paid, services must be limited to the scope of practice authorized by state law or regulation, the acupuncturist must have a current license with BoRM, and (for non-physician providers) services must be provided pursuant to a supervisory agreement with a physician.

Even thought that it says prior authorization is not required, prior authorization is likely to be required for acupuncture service because it is very difficult for an acupuncturist to become an in-network provider, and different health insurance provider that works with MassHealth works differently. Also because it is new to some insurance companies, a lot of misunderstanding is happening. For example, in the Provider Payment Guidelines for Neighborhood Health Plan, it says:

NHP reimburses participating providers for the provision of medically necessary acupuncture services for for pain relief or anesthesia. Services are reimbursed up to the maximum allowed as defined by the member’s plan benefit, when performed by a Medical Doctor (M.D.) or Doctor of Osteopathy (D.O.).

And M.D. or D.O. can not perform acupuncture legally unless they are also licensed acupuncturist. For those who are interested in reading the health law related to acupuncture in Massachusetts, here you go:

243 CMR 4.00: DISCIPLINARY PROCEEDINGS FOR ACUPUNCTURISTS
243 CMR 5.00: THE PRACTICE OF ACUPUNCTURE

Well, enough said. Let’s see how things will roll out in the next few years.

 

 

5 Comments on “MassHealth and Acupuncture

  1. Hi I need an acupuncture dr.I have mass health.
    I live in Cohasset 02025
    Thanks Johnny

  2. Hi my name is Glen Gtant I have prostate cancer I’m getting radiation treatment but I need acupuncture treatment I have mass health . would I be able to get treatment?

    • Hi Glen, I don’t think MassHealth will cover acupuncture for prostate cancer related treatment from a private provider like myself. Maybe you can try Boston Medical Center, MGH, or Dana–Farber Cancer Institute to see if they will be able to take MassHealth to help you with acupuncture. However if you have MassHealth substitute insurance such as BMC HealthNet or Celticare Health, I might be able to help you more. Good Luck!

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