A scoping review of acupuncture insurance coverage in the United States

Abstract

Background: Increasing access to non-pharmacologic pain management modalities, including acupuncture, has the potential to reduce opioid overuse. A lack of insurance coverage for acupuncture could present a barrier for both patients and providers. The objective of this scoping review was to assess the existing literature on acupuncture insurance coverage in the United States and to identify knowledge gaps and research priorities. Methods: We utilized the Arksey and O’Malley framework to guide our scoping review methodology. We followed a pre-determined study protocol for the level-one abstract and level-two full text screenings. We synthesized information into subject-area domains and identified knowledge gaps. Results: We found a lack of published data on acupuncture coverage in 44 states, especially in the Midwest and the South. Where data were available, a large proportion of acupuncture users did not have insurance coverage. Consumer demand, state mandates, and efforts to reduce opioid use were motivations to cover acupuncture. Licensed acupuncturists were less likely to be reimbursed and were reimbursed at lower rates compared to physicians. Reported barriers encountered when implementing coverage included a lack of providers, challenges determining when to offer non-pharmacologic treatments, and a lack of evidence for clinical efficacy and cost-effectiveness. Conclusion: We found a lack of recent publications and data comparing regional coverage in the United States. A key challenge is that commercial insurance plan data are not in the public domain. Further research should assess insurance coverage implementation for acupuncture and measure the impact of policy changes on acupuncture utilization and rates of opioid overuse.

Trends in Insurance Coverage for Acupuncture, 2010-2019

“… 1 , 3 , 4 For example, Medicare reimburses acupuncture for low back pain, excluding other conditions for which acupuncture is recommended. 1 , 3 …”

“… 4 When insurers covered acupuncture, cost sharing was higher than other nonpharmacological interventions, and insurers tended to cover few indications and clinician types. 3 , 4 …”

“…Given Medicare Part B’s 2020 decision to reimburse acupuncture for low back pain, we hypothesized that insurance coverage increased over time. 3 …”

Using economic evaluations to support acupuncture reimbursement decisions: current evidence and gaps

“…Clinicians in over 183 countries, motivated by increasing evidence of effectiveness,12345 use acupuncture, a non-pharmaceutical intervention, predominantly for pain relief but also in a wide variety of other conditions 6. Although private health insurance often covers acupuncture, public health insurance rarely does 78. Given the high prevalence of chronic pain,910 extensive use of acupuncture can use considerable health resources 11.…”

“…6 Although private health insurance often covers acupuncture, public health insurance rarely does. 7 8 Given the high prevalence of chronic pain, 9 10 extensive use of acupuncture can use considerable health resources. 11 Thus like other interventions, decisions about reimbursement for acupuncture should ideally include economic evaluation.…”