Summary
Independence Blue Cross reissued Policy 12.00.01i on acupuncture with code updates effective 01/01/2025. CPT codes 97811 and 97814 (add-on acupuncture codes) have been revised. The policy maintains coverage for seven specific medically necessary conditions (migraine, tension headache, postoperative/chemotherapy-induced nausea, pregnancy nausea, low back pain, chronic neck pain, and knee/hip osteoarthritis pain) while treating all other acupuncture uses as experimental/investigational and non-covered.
Get alerts when payers change rules like this one
We check Independence Blue Cross and other payers every day and email you when a change matches your specialty and state.
Get Independence Blue Cross alertsPolicy Monitoring is free. No card required.
What to do
Action · 6 steps
01By 01/01/2025: Billing team must verify CPT codes 97811 and 97814 are correctly configured in billing software with updated policy logic.
02Ensure claims for acupuncture services link to the seven medically necessary ICD-10 diagnosis codes listed in Attachment A only—all other diagnoses must be denied as experimental/investigational.
03Verify that all acupuncture claims include required medical documentation (office records, test reports, etc.) per policy requirements.
04Front desk and billing staff should update internal reference materials to reflect that coverage varies by individual member benefit contract.
05Providers must document medical necessity in patient records; claims lacking this documentation will be denied.
06No prior authorization requirement is specified, but individual member benefits must be verified before billing.
Codes mentioned
97810978119781397814S8930
Original notice
12.00.01i, Acupuncture
medpolicy.ibx.com · Always check the source before changing claims.
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