Coverage of Conditions and Treatments (Coverage Decisions)

Use this lookup tool to determine coverage decisions, or if prior authorization is needed for the treatment or condition. Note: For Self-insured employer claims, you must contact the employer or their claims administrator.

List also available in PDF format.

See Treatment Guidelines and Resources for additional information.

Acupuncture is the insertion of needles or lancets, with or without electrical stimulation, to directly or indirectly stimulate acupuncture points and meridians.

Conditions of Coverage:

The department covers acupuncture, with or without electrical stimulation, up to a maximum of 10 treatments over the lifetime of the claim, for the following conditions only:

• An accepted lumbar condition on the claim.

In addition, the following requirements must be met:

• Documentation of the referral from the attending provider must appear in the claim file, and
• The treatment provided must be only for covered conditions as stated in this policy, and
• The claim must be allowed and open, and
• The provider must submit to the claim file validated functional instruments to track and document the worker's pain and functional status at the following visits:
  • The Initial office visit/treatment, and
  • The Middle treatment, and
  • The Final treatment.

Only the medically necessary number of acupuncture treatments should be provided, up to a maximum of 10 treatments over the lifetime of the claim.

Validated functional instruments include:

• 2-item Graded Chronic Pain Scale (2-item GCPS)
• Oswestry Disability Index (ODI)

Non-covered Indications

L&I will not authorize payment for acupuncture treatment related to conditions not listed.

Billing Codes

For billing information, please refer to L&I Fee Schedules and Payment Policies (MARFS).