Does Medi-Cal Cover Acupuncture? Your 2026 Benefits Guide

Does Medi-Cal Cover Acupuncture? Your 2026 Benefits Guide

If you rely on Medi-Cal for your acupuncture care, there's news you need to hear. The Department of Health Care Services has proposed ending Medi-Cal's acupuncture benefit starting January 1, 2026 — a change that would affect thousands of Californians who depend on this treatment.

Here's how we got here. Back on July 1, 2016, Senate Bill 833 restored acupuncture coverage for Medi-Cal beneficiaries, opening the door for people dealing with chronic pain tied to recognized medical conditions.

The timing of this proposed cut feels especially difficult. More and more doctors have been turning to acupuncture as a safer alternative to opioids — a crisis that took over 29,000 lives in 2014 alone. At North East Medical Services, for example, 90% of their 20,000 patient visits since 2017 were covered by Medi-Cal. That's a lot of people getting real relief.

Right now, the benefit covers treatments meant to prevent, ease, or reduce chronic pain. Adults can receive two acupuncture sessions each calendar month, and children under 21 have no cap on their visits.

If the elimination goes through, it would pull about $13.1 million in funding from the program. For now, you can still use your benefits through 2025 — but the program's future hangs in the balance.

Who is eligible for Medi-Cal acupuncture coverage in 2026?

If you're enrolled in Medi-Cal, you currently qualify for acupuncture coverage under Senate Bill 833. That said, the Department of Health Care Services has proposed ending this benefit on January 1, 2026, so the landscape may shift.

How much coverage you get depends on your age. Kids under 21 have unlimited access — no frequency caps, no restrictions. The Early and Periodic Screening, Diagnosis, and Treatment program also gives qualifying participants that same unlimited coverage.

Adults have tighter limits. You're covered for two acupuncture sessions per calendar month, and the treatment needs to be aimed at "preventing, modifying, or alleviating the perception of severe, persistent chronic pain resulting from a generally recognized medical condition."

If you need more sessions than that, don't worry — it's not a hard stop. Your provider can request authorization for additional treatments when they're medically necessary. In fact, your primary care physician can refer you for up to 20 extra visits over a three-month period if you're responding well to treatment.

One important thing to know: your acupuncturist needs to be enrolled in the Medi-Cal program. That includes licensed physicians, dentists, podiatrists, or certified acupuncturists. Acupuncture performed during an emergency room visit or inpatient hospital stay isn't covered. And physician assistants or nurse practitioners can't bill for these services unless they're also certified acupuncturists.

What acupuncture services are covered under Medi-Cal?

Medi-Cal covers acupuncture treatments meant to "prevent, modify or alleviate the perception of severe, persistent chronic pain resulting from a generally recognized medical condition." You're covered whether your treatment includes electrical stimulation of the needles or not.

As an adult, you get two sessions each calendar month. Need more? Your provider can submit a Treatment Authorization Request (TAR) when additional care is medically appropriate.

The program uses four billing codes:

97810: Initial 15 minutes without electrical stimulation

97811: Each additional 15 minutes without electrical stimulation

97813: Initial 15 minutes with electrical stimulation

97814: Each additional 15 minutes with electrical stimulation

Each 15-minute increment is reimbursed at a maximum of $20.00.

A few things aren't covered. You can't bill acupuncture as part of emergency or inpatient care. And as mentioned earlier, physician assistants and nurse practitioners can't bill for these services unless they carry an acupuncturist certification.

The flexibility between standard and electrical stimulation treatments means your acupuncturist can tailor each session to what your body actually needs.

How to access and bill for acupuncture through Medi-Cal

Before any session begins, your provider needs to confirm your Medi-Cal eligibility for that month. This step is required every time, no exceptions.

Each outpatient visit also requires a Medi-Service reservation. Your provider handles this online when booking your appointment — it's what guarantees they'll be paid for the care they give you.

On the billing side, Medi-Cal accepts four specific CPT codes. Code 97810 covers your initial 15 minutes without electrical stimulation, and 97811 handles each extra 15-minute block. Codes 97813 and 97814 work the same way but for treatments that include electrical stimulation. Every 15-minute increment is reimbursed up to $20.00.

Here's how the reservations stack: one reservation can include a 97810 code plus up to two 97811 codes, or a 97813 code plus up to two 97814 codes. Only physicians, dentists, podiatrists, and certified acupuncturists who are enrolled in Medi-Cal can bill for these services. Emergency room visits, hospital stays, and care provided by physician assistants or nurse practitioners aren't reimbursable.

When it comes to paperwork, claims need to include the diagnosis behind your pain, any other treatments you've tried, and how those worked out. The good news? You don't need a prescription or prior authorization to start treatment.

Conclusion

For now, Medi-Cal acupuncture coverage is still available through 2025. But with the Department of Health Care Services proposing to end this benefit on January 1, 2026, thousands of Californians who rely on acupuncture for pain management could be left searching for alternatives.

One of the nice things about the current benefit is its simplicity — no prior authorization hoops to jump through. Your provider sets up treatment through the Medi-Service reservation system, and reimbursement sits at $20.00 per 15-minute increment.

Today, the program serves adults getting monthly sessions and children under 21 with unlimited access. Whether you need standard acupuncture or treatment with electrical stimulation, the coverage helps people manage chronic pain without reaching for more medication.

What happens next isn't certain. We don't yet know whether the Department of Health Care Services will move forward with eliminating the benefit and the $13.1 million that funds it.

If you're currently receiving acupuncture through Medi-Cal, you can keep your appointments going until any policy changes actually take effect. And during a time when the opioid crisis continues to hurt families across the country, this program remains a meaningful option for people who want a different path to pain relief.

FAQs

Q1. Will Medi-Cal continue to cover acupuncture services in 2026? Right now, the Department of Health Care Services has proposed ending acupuncture coverage as of January 1, 2026. Until a final decision is made, you can still use your Medi-Cal benefits to receive acupuncture.

Q2. How many acupuncture sessions does Medi-Cal currently cover per month? Adults get two sessions per calendar month. If you need more than that, your provider can request additional treatments when they're medically necessary.

Q3. What specific acupuncture services are covered under Medi-Cal? Medi-Cal covers acupuncture aimed at preventing, modifying, or easing severe, persistent chronic pain. That includes treatments both with and without electrical stimulation, billed under CPT codes 97810 through 97814.

Q4. Who can provide acupuncture services under Medi-Cal? Your acupuncturist has to be enrolled in Medi-Cal and must be a licensed physician, dentist, podiatrist, or certified acupuncturist.

Q5. Is prior authorization required for acupuncture treatments under Medi-Cal? No — you don't need a prescription or prior authorization to get started. Your provider just needs to verify your eligibility and create a Medi-Service reservation for each outpatient visit.