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Independence Blue CrossCommercial · Billing Codes · Medical Policy · Pain Management, Physical Therapy, OncologyMedium impact

12.00.01i, Acupuncture

Effective date
Jan 1, 2025
Identified
Jun 19, 2026

Summary

Independence Blue Cross reissued Medical Policy 12.00.01i on acupuncture effective 01/01/2025 with CPT code updates (97811 and 97814 revised). The policy maintains coverage for needle acupuncture for seven specific conditions (headache, postoperative/chemotherapy nausea, pregnancy nausea, low back pain, chronic neck pain, and knee/hip osteoarthritis pain) while classifying all other uses as experimental/investigational. Individual member benefits must be verified per contract, and medical necessity documentation is required for all claims.

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What to do

Action · 6 steps
01By 01/01/2025: Billing team must ensure claims processing systems correctly apply coverage limits and medical necessity criteria for CPT codes 97811 and 97814 (add-on acupuncture codes with and without electrical stimulation).
02Update claim scrubbing rules to deny acupuncture services for diagnoses not listed in Attachment A (ICD-10 codes for covered conditions: headache, postoperative nausea/vomiting, chemotherapy-induced nausea/vomiting, pregnancy nausea, low back pain, chronic neck pain, knee/hip osteoarthritis pain).
03All other diagnosis codes should route for experimental/investigational denial.
04Providers must document medical necessity in patient records per policy requirements; billing team should flag incomplete documentation for denial per policy.
05Update billing software to require individual member benefit verification before processing claims, as coverage varies by product and group.
06Billing team must request and retain all supporting medical records for Company audit purposes per policy mandate.

Codes mentioned

97810978119781397814S8930

Original notice

12.00.01i, Acupuncture
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

See all Independence Blue Cross changes →
MA12.004e, AcupunctureMediumEffective Jan 1, 2025 · Medical PolicyMA12.004e, AcupunctureMediumEffective Jan 1, 2025 · Medical Policy12.00.01i, AcupunctureMediumEffective Jan 1, 2025 · Medical PolicyMA12.004e, AcupunctureMediumEffective Jan 1, 2025 · Medical PolicyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesPain ManagementPhysical TherapyOncologyCode 97810Code 97811Code 97813Code 97814Code S8930

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