Does Humana Cover Acupuncture?

This guide explains whether Humana covers acupuncture, including medical necessity criteria, coverage limitations, provider requirements, and how to verify your benefits.

Humana offers commercial, Marketplace, and Medicare Advantage plans. Acupuncture coverage depends on your specific plan and state. Humana’s medical coverage policy for acupuncture states that it may be covered for certain conditions when specific criteria are met, but it can also be excluded entirely in many certificates. Always check your individual Summary of Benefits and Coverage (SBC) or Evidence of Coverage (EOC) to confirm your exact benefits.

Is Acupuncture Covered by Humana?

Humana’s medical policy explains that acupuncture may be covered when:

The treatment is ordered by a physician or other licensed health care practitioner, and
It is performed by a duly licensed and (where applicable) certified acupuncturist acting within their legal scope of practice, and
The member’s certificate does not exclude acupuncture.

Even when those conditions are met, Humana only considers acupuncture medically necessary for a short list of specific conditions. For other diagnoses, acupuncture may be considered experimental, investigational, or not medically necessary and therefore not covered by many plans.

Humana also administers Medicare Advantage plans, which must cover acupuncture for chronic low back pain at least at the same level as Original Medicare. Some Humana Medicare Advantage products offer clearly defined acupuncture benefits (for example, a set number of covered visits per year with a fixed copay) when used for chronic low back pain.

When Humana May Consider Acupuncture Medically Necessary

According to Humana’s acupuncture medical coverage policy, commercial plan members may be eligible for acupuncture when the above ordering and provider requirements are met and the treatment is for one of the following conditions:

Cancer-related pain
Chronic headaches (minimum of 12 consecutive weeks’ duration)
Chronic low back or neck pain (minimum of 12 consecutive weeks’ duration)
Nausea and vomiting associated with chemotherapy, postoperative recovery, or pregnancy
Osteoarthritis of the knee

For many commercial plans, treatment beyond a small initial number of visits (for example, more than five visits without documented improvement) may require review by a medical director or additional authorization, depending on the certificate’s terms.

Humana’s policy notes that state mandates for acupuncture take precedence. In states where law requires certain acupuncture coverage, the state mandate may override parts of the standard medical policy for fully insured plans.

Conditions Humana Often Does Not Cover with Acupuncture

Humana’s medical coverage policy lists many conditions for which acupuncture is not considered medically necessary and is typically not covered under the plan (unless required by state law or a special program). These non-covered or investigational indications include, but are not limited to:

Addiction or substance use disorders
Use of acupuncture for anesthesia during procedures or surgery
Asthma or chronic obstructive pulmonary disease (COPD)
Diabetic neuropathy
Dysmenorrhea or endometriosis pain
Epicondylitis (tennis or golfer’s elbow)
Fibromyalgia
Infantile colic
Infertility
Insomnia
Menopausal hot flashes
Mental health conditions (such as anxiety, panic disorder, or depression)
Obesity or weight reduction
Smoking cessation
Temporomandibular joint (TMJ) disorders
Tinnitus

Humana also generally does not cover “maintenance” acupuncture, defined as continued treatment after therapeutic goals have been achieved or when no further significant progress is expected. In most certificates, maintenance care is either specifically excluded or considered not medically necessary.

Humana Medicare Advantage and Acupuncture

Original Medicare (Part B) covers acupuncture only for chronic low back pain, up to 12 visits in 90 days, with the option for up to 8 additional visits (maximum 20 visits per year) if the patient shows improvement.

Humana Medicare Advantage plans must provide at least this same level of coverage for chronic low back pain and can choose to mirror or expand upon the Medicare benefit. Humana’s Medicare Advantage payment policy for acupuncture for chronic low back pain states that:

Acupuncture and dry needling for chronic low back pain are covered under the same chronic low back pain benefit.
Humana generally allows up to 20 sessions per calendar year for chronic low back pain, consistent with Medicare’s annual limit.
All covered acupuncture services furnished on the same date of service are treated as a single session.
Humana may allow a broader range of licensed practitioners (who meet plan requirements) to render covered acupuncture services than Original Medicare’s narrower provider list, depending on the Medicare Advantage product.
Individual Summary of Benefits documents often specify a fixed copay per visit (for example, a set dollar copay per session up to 20 visits per year for chronic low back pain).

For conditions other than chronic low back pain, Medicare Advantage coverage may be more limited or follow Humana’s commercial medical policy. Members should always check their Medicare Advantage Evidence of Coverage for detailed acupuncture benefits.

Provider Requirements and Billing Codes

When acupuncture is covered, Humana generally requires that:

The service is performed by a licensed acupuncturist or other licensed practitioner allowed by state law and by the plan.
The ordering and treating providers follow the scope of practice requirements in the state where services are performed.
All documentation clearly supports the diagnosis, the medical necessity of treatment, and the member’s progress toward functional goals.

Common CPT codes used for acupuncture claims include:

97810 – Acupuncture, one or more needles; without electrical stimulation, initial 15 minutes of one-on-one contact
97811 – Each additional 15 minutes without electrical stimulation, with reinsertion of needles
97813 – Acupuncture, one or more needles; with electrical stimulation, initial 15 minutes of one-on-one contact
97814 – Each additional 15 minutes with electrical stimulation, with reinsertion of needles

Humana cautions that the presence of a billing code in policy documents does not guarantee coverage; the member’s plan benefits and medical necessity rules always govern payment decisions.

How to Verify Your Humana Acupuncture Benefits

Call the customer service number on the back of your Humana ID card.
Ask if acupuncture is covered under your specific plan and whether it is excluded by your certificate.
Confirm which diagnoses are eligible (for example, chronic low back pain, chronic headaches, cancer-related pain, osteoarthritis of the knee, or treatment-related nausea).
Ask if prior authorization is required and whether there are visit limits per year or per episode of care.
Verify your copay, coinsurance, and deductible for acupuncture visits.
Confirm that your provider is in-network and properly credentialed with Humana for acupuncture services.

Frequently Asked Questions

Does Humana cover acupuncture?
Humana may cover acupuncture when it is not excluded by the member’s certificate and when strict medical necessity criteria are met for specific conditions such as cancer-related pain, chronic headaches, chronic low back or neck pain, nausea and vomiting related to treatment, or osteoarthritis of the knee. Coverage details vary by plan.

Is acupuncture covered for chronic low back pain under Humana Medicare Advantage?
Yes. Humana Medicare Advantage plans must at least match Original Medicare’s coverage for chronic low back pain (up to 20 visits per year, with an initial 12 visits in 90 days and up to 8 more if improvement is shown). Many Humana Medicare Advantage plans clearly list this benefit in their Summary of Benefits with a set copay per visit.

Does Humana cover acupuncture for conditions like fibromyalgia, infertility, or weight loss?
In its medical policy, Humana specifically lists multiple conditions such as fibromyalgia, infertility, obesity/weight reduction, smoking cessation, certain mental health conditions, and others as indications for which acupuncture is typically considered experimental or not medically necessary. These are usually not covered unless required by state law or by a special program.

Does Humana cover maintenance acupuncture?
No. Once therapeutic goals have been met or no further significant improvement is expected, ongoing “maintenance” acupuncture is generally not covered, either because it is excluded in the certificate or considered not medically necessary.

How many acupuncture visits will Humana cover?
For commercial plans, visit limits and review thresholds are defined in the member’s certificate and may require medical review after a small number of initial visits if improvement is not documented. For Medicare Advantage members with chronic low back pain, coverage typically follows the Medicare model (up to 20 visits per year) as described in the plan’s Evidence of Coverage.