Trends in Acupuncture Billing by a Large Commercial Insurer

ABSTRACT

Objectives: Acupuncture therapy is a safe and effective option for acute and chronic pain conditions, particularly chronic low back pain, and is an important component of nonpharmacologic pain care. Overall trends in acupuncture billing by commercial insurers are unclear.

Study Design: We conducted a retrospective, cross-sectional analysis using a large commercial insurance claims database.

Methods: Using Optum’s deidentified Clinformatics Data Mart database, we tracked acupuncture billing for a large cohort of commercially insured individuals between 2012 and 2021. We measured the primary diagnoses that acupuncture providers billed for; indications of interest included low back pain, joint pain, neck pain, and headaches and migraines.

Results: The number (and share) of patients who used their insurance to pay for acupuncture increased between 2012 and 2021, from 26,596 (0.19% of covered lives) to 30,829 (0.24% of covered lives), respectively, peaking at 43,396 (0.31% of covered lives) in 2019. The most common primary indication that providers billed for was low back pain, followed by neck pain, joint pain, and headaches and migraines. Most acupuncture users were female, White or Asian, high income, and college educated.

Conclusions: Our findings indicate that a large commercial insurer is increasingly covering acupuncture therapy for multiple pain conditions.

Am J Manag Care. 2026;32(2):In Press

Takeaway Points

• According to the CDC, opioid prescribing is declining; improving access to nonpharmacologic pain care is a public health priority.
• Our findings indicate that a large commercial insurer is increasingly covering acupuncture for its beneficiaries.
• Unlike Medicare Part B, which limits acupuncture coverage to chronic low back pain, this commercial insurer also reimbursed acupuncture for neck pain, joint pain, and headaches and migraines.
• Insurers should consider systematic reviews, meta-analyses, and other rigorous studies when expanding acupuncture coverage to new indications.

A key driver of the opioid epidemic is the high incidence of pain in the US and the challenges of treating pain safely and effectively.1,2 Prescription opioids, initially recommended for cancer and acute pain, were increasingly used for chronic noncancer pain beginning in the 1990s.2 Although medical guidelines “counseled caution,” opioid prescribing became a predominant approach to multimodal pain care.2,3 More recently, the US has experienced a pronounced decline in opioid prescribing,4-6 which has resulted in some patients with legitimate needs reporting difficulties accessing pain care.7 Surveys of providers suggest that many organizations are not in a position to deliver a “postopioid” model of pain care.8

Improving access to nonopioid pain care is a public health priority, and acupuncture therapy is a safe and effective option.9 Acupuncture involves the insertion of fine, solid-bore needles into body points or a combination of points for therapeutic benefit.10 Not only is acupuncture effective for multiple pain conditions, particularly chronic low back pain, but it also has a low-risk safety profile across systematic reviews and large trials.10-13 Acupuncture is supported or recommended as part of comprehensive pain care by the Joint Commission, the Agency for Healthcare Research and Quality, the FDA, and HHS.14-18

Despite these recommendations, insurance coverage for acupuncture is lagging compared with modalities such as physical therapy and chiropractic care.19,20 According to a nationally representative survey, half of visits with acupuncturists are covered by some insurance, and the share is increasing over time.21 However, even when insurers cover acupuncture, there can be limitations on indications and provider types. For instance, Medicare Part B’s 2020 decision to reimburse acupuncture for chronic low back pain was limited to Medicare providers,22 which excludes most licensed acupuncturists from billing Medicare directly for their services. This is despite acupuncture’s evidence base for acute and chronic pain conditions such as headaches and migraines, neck and shoulder pain, and osteoarthritis.10,23-25

Few studies have leveraged insurance claims to study acupuncture. As a result, it is unclear what trends in acupuncture billing look like overall and whether insurers are willing to cover acupuncture for other indications or are instead following in Medicare Part B’s path. In this study, we tracked trends in acupuncture billing between 2012 and 2021 by a large commercial insurer and explored the primary indications billed for, including low back pain, neck pain, joint pain, and headaches and migraines.

METHODS

We used Optum’s deidentified Clinformatics Data Mart database, which includes more than 15 million covered lives annually. Our study period was 2012 through 2021, and our study sample included any patient 18 years and older with commercial insurance. We used a repeated cross-section, where patients could use acupuncture in multiple years. The study was deemed exempt by the University of Pennsylvania’s Institutional Review Board.

First, we determined the number of unique patients and total number of acupuncture visits between 2012 and 2021. We identified acupuncture visits using Current Procedural Terminology (CPT) codes 97810, 97811, 97813, and 97814. The CPT codes 97813 and 97814 refer to electroacupuncture, which combines traditional acupuncture needling with electrostimulation. We broke down visits by the primary indications that providers billed for, which were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes between 2012 and 2017 and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes thereafter. Indications of interest included low back pain (ICD-9-CM: 724.2; ICD-10-CM: M54.5), joint pain (ICD-9-CM: 719.4; ICD-10-CM: M25.5), neck pain (ICD-9-CM: 723.1; ICD-10-CM: M54.2), other back pain such as sciatica (ICD-9-CM: 724.3; ICD-10-CM: M54.3 and M54.4), and headaches and migraines (ICD-9-CM: 784.0, 356, and 307.81; ICD-10-CM: R51, G43, and G44).

We also measured characteristics of patients who used their insurance plan to pay for acupuncture. Patient characteristics included age, sex, and race/ethnicity as well as annual household income and educational attainment, which were modeled at the household level. Optum uses a combination of data sources and proprietary algorithms to estimate income and education; each member is then assigned to a corresponding dollar range or educational attainment level. Plan characteristics included whether the plan was self-funded or fully insured; whether it was an exclusive provider organization, health maintenance organization, point-of-service plan, or preferred provider organization; and whether it was a consumer-driven health plan, which is marked by a high deductible and savings option.

In supplemental analysis, we tracked the share of covered lives with at least 1 acupuncture session by year. We calculated trends overall, then disaggregated by sex, age bands, race/ethnicity, annual household income, educational attainment, and insurance plan characteristics. We assessed whether trends were statistically significant using linear regression models with year fixed effects.

RESULTS

In total, 207,394 unique patients used acupuncture during the study period, accounting for 339,924 patient-year observations (Table). Patients who used acupuncture were predominantly female (65.4%) and White (59.4%) or Asian (18.9%), and they had a mean (SD) age of 43.0 (12.1) years. More than half (51.4%) had an annual household income greater than $100,000, and nearly half (46.6%) had 4 or more years of college education. Plans that covered acupuncture were most frequently point-of-service (82.4%), followed by exclusive provider organizations (8.3%), health maintenance organizations (4.9%), and preferred provider organizations (3.2%). Roughly 1 in 5 (20.6%) were consumer-driven health plans, and more than half (57.6%) were self-funded.

During the study period, there was an increase in the number of patients who used acupuncture at least once, from 26,596 patients in 2012 (0.19% of covered lives) to 30,829 patients in 2021 (0.24% of covered lives); utilization peaked in 2019 at 43,396 patients (0.31% of covered lives) (Figure). The number of unique visits also increased, from 211,134 in 2012 to 240,665 in 2021. Supplemental analysis showed that the trend was consistent across demographics, socioeconomic characteristics, and insurance plan types (eAppendix Figure [available at ajmc.com]). A notable exception was fully insured plans, in which rates of acupuncture use remained stable. The rate of acupuncture use in 2021 was significantly higher than in 2012 (P < .001).

Providers most commonly billed for acupuncture to treat low back pain, followed by neck pain, joint pain, other back pain such as sciatica, and headaches and migraines. In 2021, low back pain accounted for 26.9% of visits, neck pain for 25.7% of visits, joint pain for 14.5% of visits, other back pain such as sciatica for 7.7% of visits, and headaches and migraines for 5.5% of visits. Other diagnoses, which accounted for 19.7% of visits, included segmental and somatic dysfunction (4.7% of visits in 2021), pain in limb (4.5% of visits in 2021), and chronic pain not otherwise specified (2.2% of visits in 2021).

DISCUSSION

We assessed acupuncture billing by a large commercial insurer between 2012 and 2021, and our findings demonstrated an increase in reimbursed acupuncture visits over the study period. The COVID-19 pandemic was a notable disruption, which we explored elsewhere.26 The indications most frequently billed for were low back pain, neck pain, joint pain, other back pain, and headaches and migraines. The demographic profile of insured acupuncture users was characterized by higher representation among women, White and Asian populations, individuals with higher incomes, and those with college-level education.

These findings are relevant because the pain care landscape is shifting. After reaching a peak of 80 opioid prescriptions per 100 persons in the years 2010-2012, 37.5 prescriptions per 100 persons were dispensed in 2023.5 Deprescribing opioids, however, has been linked to adverse outcomes, including mental health crises.27 Thus, ensuring ready access to nonopioid pain care is essential for the nearly 50 million Americans who live with chronic pain (ie, pain lasting for 3 months or longer), the 20 million Americans who live with high-impact chronic pain (pain that restricts activities of daily life), and millions more who experience acute pain (severe pain lasting less than 3 months).1

Our results point to potential disparities in the use of acupuncture. In our sample of commercially insured individuals, we found that most acupuncture users were female, White or Asian, high income, and/or college educated. Although differences in the characteristics of acupuncture users may reflect differences in preferences for pain care, they could also represent barriers in access, such as lack of proximity to acupuncture providers or inability to pay out-of-pocket costs for acupuncture.20,28

Differences in use could also reflect knowledge gaps about acupuncture, which may extend to patients, providers, and insurers. Although acupuncture is sometimes labeled an alternative or complementary therapy, it is evidence based; findings from rigorous randomized controlled trials (RCTs) and systematic reviews with meta-analyses demonstrate that acupuncture alleviates pain. For instance, an individual patient data meta-analysis of 20,827 patients from 39 trials demonstrated that acupuncture had clinically meaningful benefits for pain, with 85% of improvement persisting 1 year after a course of acupuncture treatment.10 A more recent RCT found acupuncture to be effective for sciatica associated with lumbar disc herniation, with benefits lasting a full year,29 and a large, multisite trial found acupuncture to be effective specifically for chronic low back pain in individuals 65 years and older compared with usual care.30 In addition to effectiveness studies, acupuncture has been shown to be cost-effective.31-33 According to Ng et al, more acupuncture use is associated with reduced health care expenditures among breast cancer survivors with pain.34 Moreover, acupuncture is included in multiple medical guidelines; for example, the American College of Physicians recommends acupuncture for acute, subacute, and chronic low back pain,35 and the Joint Commission recommends that hospitals provide acupuncture as part of nonopioid pain care.14

Yet expecting a robust evidence base to increase insurance coverage of acupuncture is challenging, in part because effectiveness trials and medical guidelines often do not include outcomes such as cost savings. More research leveraging insurance claims could shed light on the potential value of acupuncture. Insurance claims could also be used to learn more about acupuncture use among large and diverse samples of patients, to assess conditions specifically responsive to acupuncture, and to determine whether there is a cadence, frequency, and dosage of acupuncture visits that is most effective, informing a course of care that insurers might cover.

Limitations

This study had notable limitations. First, we relied on data from a single commercial insurer, which limits generalizability. Research that explores acupuncture use in other commercial insurers, Medicare, and Medicaid is warranted. Second, we could track only acupuncture that was billed to insurance, and we did not assess acupuncture use among all patients who were diagnosed with pain conditions. A recent study did track acupuncture use among patients with low back pain,36 but additional research that tracks acupuncture use among patients with neck pain, joint pain, and headaches and migraines is needed. Third, we did not account for the degree of acupuncture’s evidence base across indications. Insurers should consider systematic reviews, meta-analyses, and other rigorous studies when expanding acupuncture coverage to new indications.

CONCLUSIONS

According to the CDC, opioid prescribing is declining nationwide.5 Insurers play an important role in facilitating access to nonopioid pain care. Our findings demonstrate that 1 large commercial insurer is increasingly reimbursing acupuncture therapy and that unlike in Medicare Part B, coverage extends to multiple pain conditions.

Author Affiliations: Departments of Psychiatry and Health Care Management, University of Pennsylvania (MC), Philadelphia, PA; Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai (AN), New York, NY; Susan Samueli Integrative Health Institute and the Department of Medicine, University of California Irvine (JAD), Irvine, CA.

Source of Funding: Dr Candon reports support from the National Center for Complementary and Integrative Health (K01AT011776: Insurance Coverage for Acupuncture). Dr Dusek reports partial support from the National Center for Complementary and Integrative Health (R01AT010598: Acupuncture in the Emergency Department for Pain Management: A BraveNet Multi-Center Feasibility Study). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.

Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (MC, AN, JAD); acquisition of data (MC); analysis and interpretation of data (MC, AN); drafting of the manuscript (MC, AN, JAD); critical revision of the manuscript for important intellectual content (AN, JAD); statistical analysis (MC); provision of patients or study materials (MC); obtaining funding (MC); and supervision (JAD).

Address Correspondence to: Molly Candon, PhD, University of Pennsylvania, 3535 Market St, 3rd Floor, Philadelphia, PA 19104. Email: candon@upenn.edu.

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