Effective January 1, 2019, AmeriHealth will offer a new acupuncture benefit to all AmeriHealth Pennsylvania members. In addition, we are working to expand our network to include acupuncture providers to better serve all AmeriHealth New Jersey and AmeriHealth Pennsylvania members.  

Benefit details

Acupuncture will be considered medically necessary under certain conditions, limited to:

• Headache (migraine and tension)
• Post-operative and chemotherapy-induced nausea and vomiting
• Nausea of pregnancy
• Low back pain
• Pain from osteoarthritis of the knee and hip
• Chronic neck pain

The use of acupuncture for other conditions will be considered experimental/investigational and will not be covered.

AmeriHealth New Jersey provides coverage for acupuncture for consumer and small group members as a care or treatment by means only when used as a substitute for other forms of anesthesia.

Providers should use the Eligibility and Benefits Inquiry transaction on the NaviNet^? web portal to confirm member benefits.

Acupuncture network

If you are licensed to practice acupuncture in your state, you may join the AmeriHealth network. For information on our network credentialing process, please visit the websites for AmeriHealth New Jersey or AmeriHealth Pennsylvania. You can apply by completing the online Provider Participation Form.

Note: The licensing rules for acupuncturists differ by state. Providers should refer to their state?s licensing board for guidelines.

If you meet the criteria to join our network, your information will be displayed in our Find a Doctor tool for AmeriHealth New Jersey or AmeriHealth Pennsylvania. We ask that you submit your application early to allow AmeriHealth time to review and process your credentialing request.

If you have questions about the network or credentialing process, please email us at ahnjcontracting@amerihealth.com for AmeriHealth New Jersey or at prvrequests@amerihealth.com for AmeriHealth Pennsylvania.

Updated policy

Medical Policy #12.00.01f: Acupuncture was expanded to capture information related to this new benefit for AmeriHealth Pennsylvania members. It was posted as a Notification on October 2, 2018, and will go into effect January 1, 2019.

To view the Notification for this policy, visit our Medical Policy Portal and select Accept and Go to Medical Policy Online. Then select Active Notifications.

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