Blue Shield of California & Acupuncture

Coverage Overview

Blue Shield of California covers acupuncture under most of its individual and group health plans as part of its commitment to whole-person care. Blue Shield has been particularly progressive in covering acupuncture for a wide range of conditions, including mental health conditions and fertility-related care. Nature Acupuncture & Herbs accepts Blue Shield of California insurance.

Blue Shield acupuncture coverage applies to medically necessary treatment provided by a licensed acupuncturist (L.Ac.). Most plans cover 12-30 visits per year depending on the plan tier and the condition being treated. Blue Shield PPO plans typically allow both in-network and out-of-network acupuncture with different cost-sharing levels. Coverage is subject to your deductible and a specialist or primary care copay.

What's Typically Covered

• ◈12-30 visits per year (plan dependent)
• ◈Broad covered condition list including mental health
• ◈PPO plans cover both in-network and out-of-network
• ◈Chronic pain, headaches, nausea, anxiety, and more
• ◈Fertility and reproductive health covered on select plans
• ◈Subject to deductible and copay

How to Check Your Own Blue Shield of California 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?”