Medi-Cal & Acupuncture

Coverage Overview

Medi-Cal - California's Medicaid program - covers acupuncture for eligible members as a covered medical benefit. Since 2020, Medi-Cal has included acupuncture as a standard benefit across most managed care plans, recognizing it as an effective treatment for pain management and helping to reduce opioid dependency. Nature Acupuncture & Herbs accepts Medi-Cal at our Los Angeles locations.

Medi-Cal covers up to a specified number of acupuncture visits per year for medically necessary conditions. The covered provider must be a licensed acupuncturist (L.Ac.) enrolled in the Medi-Cal system. Coverage is available through most Medi-Cal managed care plans (Molina, etc.) and Fee-for-Service Medi-Cal. There is typically no copay for Medi-Cal members.

What's Typically Covered

• ◈No copay for eligible Medi-Cal members
• ◈Acupuncture covered as medically necessary
• ◈Chronic pain management (back pain, joint pain, headaches)
• ◈Available through most Medi-Cal managed care plans
• ◈Licensed acupuncturist (L.Ac.) required as provider
• ◈Pre-authorization may be required for some plans

How to Check Your Own Medi-Cal 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?”