UnitedHealthcare & Acupuncture

Coverage Overview

UnitedHealthcare (UHC) covers acupuncture under most of its commercial plans, including employer-sponsored PPO, HMO, and Choice Plus plans. UHC has expanded its acupuncture benefits in recent years, particularly for chronic pain conditions, as part of its broader focus on reducing opioid use. Nature Acupuncture & Herbs is in-network with UnitedHealthcare.

UnitedHealthcare acupuncture benefits typically include 10-20 visits per year for covered conditions. Coverage applies when treatment is medically necessary and provided by a licensed acupuncturist enrolled in the UHC network. UHC PPO plans (such as Choice and Choice Plus) generally allow both in-network and out-of-network acupuncture. Visits are subject to your plan's deductible and specialist copay.

What's Typically Covered

• ◈10-20 visits per year on most commercial plans
• ◈Chronic low back pain, headaches, nausea covered
• ◈PPO plans allow in-network and out-of-network
• ◈May be covered under complementary/alternative medicine benefit
• ◈Subject to deductible and specialist copay
• ◈UHC Optum supplement programs available on select plans

How to Check Your Own UnitedHealthcare Benefit

Plan documents are written for the plan, not for you. Two people with the same carrier on their card can have completely different acupuncture benefits, because the employer chooses the design. Anything below describes what the carrier publishes; only a call against your own member ID tells you what you have.

Before you call

• ◈Your member ID and group number, both on the front of your card
• ◈The member services phone number from the back of your card
• ◈Your date of birth and the subscriber name, if the plan is not in your name
• ◈A rough description of what you want treated, and how long you have had it

What to ask, word for word

1. 1.“Is acupuncture a covered benefit on my plan, and does it need prior authorization or a referral?”
2. 2.“Are CPT codes 97810, 97811, 97813 and 97814 covered, and how many units per visit?”
3. 3.“How many acupuncture visits am I allowed per year, and how many have I used?”
4. 4.“What is my copay or coinsurance for acupuncture, and does my deductible apply first?”
5. 5.“Is a licensed acupuncturist (L.Ac.) an eligible provider type, or must it be an MD or DC?”
6. 6.“Does coverage depend on the diagnosis, and which conditions are eligible?”