The Department of Health Care Services has proposed eliminating Medi-Cal acupuncture coverage effective January 1, 2026. The proposal would end a benefit that currently serves thousands of patients across California.
Medi-Cal beneficiaries gained access to acupuncture services through Senate Bill 833, which restored the coverage for all eligible beneficiaries on July 1, 2016. The services target persistent chronic pain resulting from recognized medical conditions.
The proposed elimination comes as healthcare providers increasingly turn to alternative pain management methods amid the ongoing opioid crisis, which claimed more than 29,000 lives in 2014. North East Medical Services reports that 90% of its 20,000 patient visits since 2017 were funded by Medi-Cal.
The coverage currently includes treatments designed to prevent, modify, or alleviate chronic pain conditions. Adult beneficiaries receive two acupuncture services per calendar month, while children under 21 have unrestricted access.
The potential elimination would affect an estimated $13.1 million in ongoing funding currently allocated to acupuncture benefits. Eligible beneficiaries can still access these services through 2025, though the future of the program remains uncertain pending final policy decisions.
Who is eligible for Medi-Cal acupuncture coverage in 2026?
Medi-Cal provides acupuncture insurance coverage to all eligible beneficiaries under Senate Bill 833, which restored the benefit in 2016. The Department of Health Care Services has proposed eliminating this coverage starting January 1, 2026.
Eligibility criteria differ significantly between age groups. Children under 21 years receive unrestricted access with no frequency limitations. The Early and Periodic Screening, Diagnosis, and Treatment program extends the same unlimited access to qualifying participants.
Adult beneficiaries face more restrictive coverage. Medi-Cal covers two acupuncture services per calendar month for adults. The treatments must “prevent, modify or alleviate the perception of severe, persistent chronic pain resulting from a generally recognized medical condition”.
Additional treatments require provider authorization when medically necessary[52]. Primary care physicians can refer patients for twenty extra visits within a three-month period if beneficial results occur.
Coverage requires treatment by specific healthcare professionals enrolled in the Medi-Cal program. Eligible providers include physicians, dentists, podiatrists, or certified acupuncturists[91]. Services provided during emergency or inpatient care are not reimbursable. Physician assistants and nurse practitioners cannot bill for acupuncture services unless they hold acupuncturist certification.
What acupuncture services are covered under Medi-Cal?
Medi-Cal covers acupuncture treatments designed to “prevent, modify or alleviate the perception of severe, persistent chronic pain resulting from a generally recognized medical condition”. The coverage includes treatments both with and without electrical stimulation of the needles.
Beneficiaries receive two acupuncture services per calendar month. Additional sessions may be approved through Treatment Authorization Requests (TARs) when medically necessary.
Four procedure codes are billable under the program:
- 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 service receives reimbursement at a maximum rate of $20.00 per 15-minute increment.
The program excludes certain scenarios. Acupuncture cannot be billed as emergency or inpatient care. Physician assistants and nurse practitioners cannot bill for acupuncture services unless they hold certification as acupuncturists.
The coverage allows practitioners to tailor treatments to individual patient needs and specific pain conditions through the electrical stimulation options.
How to access and bill for acupuncture through Medi-Cal
Providers must verify patient eligibility for the month of service before acupuncture services can begin. The verification process is required for all Medi-Cal acupuncture treatments.
Each outpatient acupuncture visit requires a Medi-Service reservation. Providers make these reservations online during appointment scheduling. The reservation system ensures providers receive payment for rendered services.
Medi-Cal accepts four specific Current Procedural Terminology (CPT) codes for acupuncture billing. Code 97810 covers the initial 15 minutes without electrical stimulation, while 97811 applies to each additional 15-minute increment without stimulation. Codes 97813 and 97814 cover the same time periods but with electrical stimulation. Each service receives a maximum reimbursement rate of $20.00 per 15-minute increment.
One reservation may include either one 97810 code plus up to two 97811 codes, or one 97813 code plus up to two 97814 codes. Only physicians, dentists, podiatrists, or certified acupuncturists enrolled in the Medi-Cal program can provide billable services. Emergency and inpatient treatments are not reimbursable, nor are services performed by physician assistants or nurse practitioners.
Claims require complete documentation including the diagnosis of the pain-causing condition, other treatments provided, and results of those treatments. Acupuncture services do not require prescriptions or prior authorization.
Conclusion
Medi-Cal acupuncture coverage remains available through 2025, though the Department of Health Care Services has proposed ending the benefit on January 1, 2026. The proposal would eliminate a pain management treatment option currently used by thousands of beneficiaries across California.
The acupuncture benefit operates without requiring prior authorization, unlike many specialized medical services. Providers can schedule treatments through the Medi-Service reservation system, with reimbursement rates set at $20.00 per 15-minute increment.
Current beneficiaries include both adults receiving monthly treatments and children under 21 with unrestricted access. The program addresses chronic pain conditions through treatments with and without electrical stimulation, providing alternatives to conventional medication approaches.
However, it’s unknown if the Department of Health Care Services will finalize the elimination proposal. The decision would affect ongoing funding of $13.1 million currently allocated to acupuncture benefits.
Patients currently receiving acupuncture treatments through Medi-Cal can continue accessing services until any policy changes take effect. The program continues to serve as an alternative pain management option while the opioid crisis affects communities across the nation.
FAQs
Q1. Will Medi-Cal continue to cover acupuncture services in 2026? As of now, the Department of Health Care Services has proposed eliminating acupuncture coverage starting January 1, 2026. Until then, eligible beneficiaries can still access acupuncture services through Medi-Cal.
Q2. How many acupuncture sessions does Medi-Cal currently cover per month? For adult beneficiaries, Medi-Cal generally covers two acupuncture services per calendar month. However, additional treatments may be authorized if deemed medically necessary.
Q3. What specific acupuncture services are covered under Medi-Cal? Medi-Cal covers acupuncture treatments designed to prevent, modify, or alleviate severe, persistent chronic pain. This includes treatments with and without electrical stimulation, billed under specific CPT codes (97810-97814).
Q4. Who can provide acupuncture services under Medi-Cal? Acupuncture services must be delivered by approved professionals enrolled in the Medi-Cal program, including physicians, dentists, podiatrists, or certified acupuncturists.
Q5. Is prior authorization required for acupuncture treatments under Medi-Cal? No, acupuncture services don’t require a prescription or prior authorization. However, providers must verify patient eligibility and make a Medi-Service reservation for each outpatient acupuncture visit.