130 CMR, § 433.440

Current through Register 1536, December 6, 2024

Section 433.440 - Acupuncture

(A)Introduction. MassHealth members are eligible to receive acupuncture for the treatment of pain as described in 130 CMR 433.440(C), for use as an anesthetic as described in 130 CMR 433.454(C), and for use for detoxification as described in 130 CMR 418.406(C)(3): Substance Abuse Treatment: Acupuncture Detoxification.

(B)General. 130 CMR 433.440 applies specifically to physicians and midlevel practitioners who are licensed practitioners of acupuncture.

(C)Acupuncture for the Treatment of Pain. MassHealth provides a total of 20 sessions of acupuncture for the treatment of pain per member per year without prior authorization. If the member's condition, treatment, or diagnosis changes, the member may receive more sessions of medically-necessary acupuncture treatment with prior authorization.

(D)Provider Qualifications for Acupuncture. MassHealth pays for acupuncture services only when the provider rendering the service is:

(1) a physician; or

(2) a midlevel practitioner who is licensed in acupuncture by the Massachusetts Board of Registration in Medicine under 243 CMR 5.00: The Practice of Acupuncture.

(E)Conditions of Payment. The MassHealth agency pays providers qualified to render acupuncture services in accordance with 130 CMR 433.440(D) for acupuncture services only when

(1) the services are limited to the scope of practice authorized by state law or regulation (such as 243 CMR 5.00: The Practice of Acupuncture); and

(2) the provider has a current license or certificate of registration from the Massachusetts Board of Registration in Medicine.

(F)Acupuncture Claims Submissions.

(1) Providers eligible to render acupuncture services in accordance with 130 CMR 433.440(D) may submit claims for acupuncture services when they provide those services directly to MassHealth members. See Subchapter 6 of the Physician Manual for service code descriptions and billing requirements.

(2) For MassHealth members receiving services under any of the acupuncture codes on the same date of service as an office visit, the provider may bill for either an office visit or the acupuncture code, but may not bill for both an office visit and the acupuncture code for the same member on the same date when the office visit and the acupuncture services are performed in the same location. This limitation does not apply to a significant, separately identifiable office visit provided by the same provider on the same day of the acupuncture service.