Does Highmark Group Cover Acupuncture?

This guide explains whether Highmark Group (including Highmark Blue Cross Blue Shield plans) covers acupuncture, including medical necessity rules, coverage limitations, provider requirements, and pre-authorization criteria.

Highmark is a parent organization for multiple Blue Cross Blue Shield plans and affiliated companies (plan names and benefits vary by state). Acupuncture coverage under “Highmark” is not automatically included on every plan. Whether acupuncture is covered depends on your specific Highmark plan, your state/region, and the benefits listed in your Summary of Benefits and Evidence of Coverage.

Is Acupuncture Covered by Highmark?

Highmark acupuncture coverage varies by product and employer contract. Common patterns include:

Commercial/employer plans: Some employer plans include acupuncture benefits; others exclude acupuncture unless a complementary/alternative medicine benefit is added.
Individual/Marketplace plans: Coverage varies by state and product. Some plans may list acupuncture with a copay/coinsurance; others may not cover it.
Medicare Advantage: Many Medicare Advantage plans follow Medicare’s rules for acupuncture for chronic low back pain and may include additional supplemental benefits depending on the product.
Medicaid-managed plans: If administered through a state program, coverage is state-specific and may require prior authorization and diagnosis limits.

Bottom line: You must confirm acupuncture as a covered benefit on your exact Highmark plan before scheduling treatment.

When Acupuncture May Be Covered

When acupuncture is covered by a Highmark plan, it is typically tied to medical necessity and may be limited to specific conditions or treatment goals. Coverage is more likely when:

Your plan explicitly lists acupuncture as a covered benefit.
The diagnosis meets medical necessity criteria.
You use in-network providers (if required by your plan).
Any required authorization or referral rules are met.

Common Limitations and Exclusions

Even when acupuncture is covered, Highmark plans commonly apply restrictions such as:

Visit limits: An annual maximum number of covered visits, or limits per condition/episode of care.
Prior authorization: Some plans require authorization before starting care, especially for extended treatment plans.
Network requirements: Coverage may require in-network providers; out-of-network acupuncture may be limited or not covered.
Wellness vs. treatment: Acupuncture for general wellness may not be covered unless the plan specifically includes it.

Medicare Advantage and Acupuncture

If you have a Highmark Medicare Advantage plan, acupuncture coverage often follows Medicare’s national rules for chronic low back pain. Coverage typically includes:

Up to 12 visits in 90 days, and
Up to 8 additional visits if improvement is documented (up to 20 visits per year).

Copays, provider eligibility, and referral rules vary by plan. Always confirm details in your plan’s Evidence of Coverage.

Provider Requirements and Billing Codes

If acupuncture is covered, services generally must be provided by a properly licensed and credentialed provider under your plan’s network rules. Confirm network status and any authorization requirements before care begins.

Common CPT codes used for acupuncture include:

97810 – Acupuncture, initial 15 minutes (no electrical stimulation)
97811 – Each additional 15 minutes (no electrical stimulation)
97813 – Acupuncture, initial 15 minutes (with electrical stimulation)
97814 – Each additional 15 minutes (with electrical stimulation)

How to Verify Your Highmark Acupuncture Benefits

Call the member services number on the back of your Highmark ID card.
Ask: “Is acupuncture a covered benefit on my plan?”
Confirm covered diagnoses (if applicable), visit limits, and cost-sharing (copay/coinsurance/deductible).
Ask whether prior authorization is required before treatment.
Verify network requirements and whether out-of-network acupuncture is ever covered.
Request the benefit reference (EOC section name or benefit code) so you can document what you were told.

Frequently Asked Questions

Does Highmark cover acupuncture?
It depends on your plan. Some Highmark plans cover acupuncture, while others exclude it unless a complementary/alternative medicine benefit is included. Verify coverage in your plan documents or with member services.

Do I need prior authorization?
Some Highmark plans require prior authorization for acupuncture, especially for extended treatment. Confirm requirements before scheduling visits.

How many acupuncture visits are covered?
If covered, many plans apply annual visit caps or limits per condition. Your exact limit is listed in your Summary of Benefits or Evidence of Coverage.

Is acupuncture covered for general wellness?
Typically no. Coverage is usually limited to medically necessary treatment for covered conditions unless the plan specifically includes wellness acupuncture.

Does Highmark Medicare Advantage cover acupuncture?
Many Medicare Advantage plans cover Medicare-allowed acupuncture for chronic low back pain, typically up to 20 visits per year when criteria are met.