Acupuncture and alternative treatments: 34% of denials overturned

Year by year

By treatment

Treatments with at least 20 decisions, most decisions first. Rates on fewer than 20 decisions aren’t shown.

Recent decisions

The most recent decisions in the data, half overturned and half upheld. Each shows the reviewer’s published findings.

1. Upheld 2025 · Medical necessity · age 21–30 Acupuncture · Infection The physician reviewer found that a patient has requested authorization and coverage for acupuncture. Current medical literature supports an acupuncture trial for the treatment of chronic pain. Per the medical records, the patient has chronic pain. However…

   The physician reviewer found that a patient has requested authorization and coverage for acupuncture. Current medical literature supports an acupuncture trial for the treatment of chronic pain. Per the medical records, the patient has chronic pain. However, the submitted records indicate that the enrollee's need for acupuncture has not been clinically evaluated. In this clinical setting, while the patient presents with chronic pain, given the lack of clinical details in the submitted record, acupuncture is not medically necessary for the treatment of this patient. Final Result: The reviewer determined that the requested service is not medically necessary for the treatment of the patient's medical condition. Therefore, the Health Plan's denial should be upheld. Credentials/Qualifications: The reviewer is licensed L.Ac., board-certified in oriental medicine and acupuncture, and is actively practicing. The reviewer is an expert in the treatment of the patient's medical condition and knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.

   Case MN25-45431

2. Upheld 2025 · Medical necessity · age 31–40 Other · Bones, joints and muscles The physician reviewer found that Nature of Statutory Criteria/Case Summary: A patient has requested authorization and coverage for massage therapy services.A review of the scientific literature on chronic low back pain with or without co-existing idiopathic…

   The physician reviewer found that Nature of Statutory Criteria/Case Summary: A patient has requested authorization and coverage for massage therapy services.A review of the scientific literature on chronic low back pain with or without co-existing idiopathic scoliosis and the use of massage therapy reveals limited or inconclusive evidence supporting its therapeutic benefit. A recent systematic review and meta-analysis found that while massage therapy may provide short-term relief when used as an adjunct to conventional care, it did not significantly impact pain intensity, quality of life, or lumbar range of motion. Additionally, a focused review on the use of myofascial release for low back pain in idiopathic scoliosis reported equivocal findings on its benefit, suggesting more studies with larger sample sizes were needed. Based on the records reviewed, there was no medical documentation of prior benefit from massage therapy. Based on several systematic reviews, there does not appear to be a persistent long-term benefit from massage therapy in cases of chronic back pain, in the setting of scoliosis. Although the patient indicated that they would like to use more holistic therapies, there are other available treatment modalities in lieu of opioid medications and massage therapy. Given these findings, the request for massage therapy for the treatment of chronic low back pain in the setting of congenital scoliosis is not indicated for the management of this patient’s condition. Therefore, the requested massage therapy services are not medically necessary for the treatment of this patient. Final Result: The reviewer determined that the requested services are not medically necessary for the treatment of the patient's medical condition. Therefore, the Health Plan's denial should be upheld. Credentials/Qualifications: The reviewer is board-certified in physical medicine and rehabilitation and is actively practicing. The reviewer is an expert in the treatment of the enrollee's medical condition and knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.

   Case MN25-44663

3. Overturned 2025 · Experimental or investigational · age 0–10 Other · Brain and nerves The physician reviewer found that Nature of Statutory Criteria/Case Summary: The parent of a patient has requested authorization and coverage for hippotherapy treatment. Hippotherapy is a type of equine therapy in which the movements of the horse are used to…

   The physician reviewer found that Nature of Statutory Criteria/Case Summary: The parent of a patient has requested authorization and coverage for hippotherapy treatment. Hippotherapy is a type of equine therapy in which the movements of the horse are used to improve postural control, balance, and sensory processing. According to one review, “Hippotherapy can be an effective intervention to improve several aspects related to postural control, such as status balance (especially in the sitting posture), dynamic balance, and alignment (body posture) in children aged 3 to 16 years, particularly with spastic hemiplegia or diplegia.” Hippotherapy has been utilized for decades to help with postural control and balance, as well as sensory processing and proprioception. Based on review of the literature, hippotherapy can be immensely helpful for an appropriately selected patient. For patients such as this child, where conventional physical therapy has not provided significant or sustained benefit, hippotherapy provides a different, promising approach. All told, the requested hippotherapy treatment is likely to be more beneficial for the treatment of this patient’s condition than any available standard therapy. Findings: Three of the three reviewers found that the requested treatment is likely to be more beneficial for the treatment of the patient's medical condition than any available standard therapy. Final Result: The reviewers determined that the requested treatment is likely to be more beneficial for the treatment of the patient's medical condition than any available standard therapy. Therefore, the Health Plan's denial should be overturned. Credentials/Qualifications: Reviewer 1 is board-certified in pediatrics with subspecialty certification in pediatric critical care medicine and is actively practicing. Reviewer 2 is board-certified in pediatrics with subspecialty certification in pediatric critical care medicine and is actively practicing. Reviewer 3 is board-certified in pediatric rehabilitation medicine and is actively practicing. The reviewers are experts in the treatment of the patient’s medical condition and knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.

   Case EI25-44883

4. Upheld 2024 · Medical necessity · age 51–64 Acupuncture · Bones, joints and muscles The physician reviewer found that Nature of Statutory Criteria/Case Summary: A patient with a diagnosis of chemotherapy-induced neuropathy has requested authorization and coverage for weekly acupuncture. In this case, the patient presents with chronic…

   The physician reviewer found that Nature of Statutory Criteria/Case Summary: A patient with a diagnosis of chemotherapy-induced neuropathy has requested authorization and coverage for weekly acupuncture. In this case, the patient presents with chronic chemical chemotherapy-induced neuropathy and extreme joint pain. Although the patient reported that prior acupuncture care was beneficial in reducing symptoms, the records do not document measurable medication intake reduction or a greater than 30% improvement in Oswestry Disability Index (ODI) scores. In addition, there is a lack of pre- and post-acupuncture baselines in terms of activities of daily living, range of motion, function, and grip for comparison purposes. After an unreported number of prior acupuncture sessions, the total number of sessions completed, and/or any measurable, progressive, significant, objective functional improvement obtained with previous acupuncture were not documented to support an indication for additional acupuncture. Therefore, the requested weekly acupuncture is not medically necessary for the treatment of this patient. Final Result: The reviewer determined that the requested services are not medically necessary for the treatment of the patient’s medical condition. Therefore, the Health Plan’s denial should be upheld. Credentials/Qualifications: The reviewer is licensed L.Ac., board-certified in oriental medicine and acupuncture, and is actively practicing. The reviewer is an expert in the treatment of the enrollee’s medical condition and knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.

   Case MN24-43006

5. Upheld 2024 · Medical necessity · age 51–64 Other · Bones, joints and muscles The physician reviewer found that Nature of Statutory Criteria/Case Summary: The patient requested authorization and coverage for aquatic therapy two times a week.Chronic low back pain is a common musculoskeletal disease. One common rehabilitative method is…

   The physician reviewer found that Nature of Statutory Criteria/Case Summary: The patient requested authorization and coverage for aquatic therapy two times a week.Chronic low back pain is a common musculoskeletal disease. One common rehabilitative method is aquatic physical therapy. The authors of a study indicated that aquatic therapy has the potential to benefit patients with chronic low back pain, but high-quality controlled trials are still required to verify the efficacy of this type of rehabilitative modality. The authors of a study reviewing the benefits of aquatic therapy later confirmed that high-quality clinical investigations are still needed to support the use of therapeutic aquatic exercise in a clinical setting. In this case, the patient has experienced an exacerbation of her chronic lower back pain and lumbar radiculopathy that interferes with her ability to perform daily activities and mobility. The record establishes that the patient has received physical therapy, including aquatic therapy, in the past. Overall, there is a lack of medical literature indicating the efficacy of aquatic therapy in reducing low back pain. There are no issues with the patient that prevent the patient from participating in land-based physical therapy such as rheumatoid arthritis or severe osteoarthritis of the knee or hip joints. Thus, the requested aquatic therapy two times a week is not medically necessary for the treatment of the patient. Final Result: The reviewer determined that the requested services are not medically necessary for the treatment of the patient’s medical condition. Therefore, the Health Plan’s denial should be upheld. Credentials/Qualifications: The reviewer is board-certified in physical medicine and rehabilitation and is actively practicing. The reviewer is an expert in the treatment of the enrollee’s medical condition and knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.

   Case MN24-42867

6. Upheld 2024 · Medical necessity · age 41–50 Acupuncture · Brain and nerves The physician reviewer found that A 41-year-old male with a history of persistent postural-perceptual dizziness has requested reimbursement for acupuncture services. In this case, the patient had persistent postural-perceptual dizziness. The patient’s…

   The physician reviewer found that A 41-year-old male with a history of persistent postural-perceptual dizziness has requested reimbursement for acupuncture services. In this case, the patient had persistent postural-perceptual dizziness. The patient’s diagnoses included cervicalgia-neck pain, nausea, and dizziness. The patient’s provider reported that the patient had undergone prior and extensive acupuncture care, which had been somewhat beneficial in reducing symptoms. However, the reduction in symptoms was not reflected in the records submitted for review. The records lack documentation of measurable medication intake reduction, an improvement in Oswestry Disability Index (ODI) score greater than 30%, and/or pre and post-acupuncture baseline activities of daily living (ADL), range of motion, and function, for comparison purposes. There is also no documentation of a quantifiable response to treatment after completion of prior acupuncture sessions to support the reasonableness and need for the acupuncture services rendered to the patient. Specifically, there is no documentation of any measurable, progressive, significant, and objective functional improvement. Overall, the records do not demonstrate quantifiable medication intake reduction and/or improvements in the patient’s ADL directly attributable to prior acupuncture sessions. For these reasons, the acupuncture services were not medically necessary for the treatment of the patient. Final Result: The reviewer determined that the services at issue were not medically necessary for the treatment of the patient’s medical condition. Therefore, the Health Plan’s denial should be upheld.

   Case MN24-42580

7. Overturned 2024 · Medical necessity · age 31–40 Acupuncture · Bones, joints and muscles Nature of Statutory Criteria/Case Summary: The patient has requested authorization and coverage for acupuncture. In a study aimed to analyze the efficacy of acupuncture alone or combined with physical therapy compared to other treatment interventions for…

   Nature of Statutory Criteria/Case Summary: The patient has requested authorization and coverage for acupuncture. In a study aimed to analyze the efficacy of acupuncture alone or combined with physical therapy compared to other treatment interventions for relieving pain and improving function in rotator cuff diseases, researchers conclude that based on current clinical data, acupuncture alone or combined with physical therapy is efficacious for short- and medium-term pain relief and functional improvements. Researchers report, “The use of acupuncture to treat impingement syndrome seems to be a safe and reliable technique to achieve clinically significant results.” A researcher states, “Ultrasound guidance of acupuncture needles into areas of rotator cuff tendon injury simulates many of the current nonoperative treatment modalities sports medicine has to offer for rotator cuff tendinopathy.” In a systematic review and meta-analysis on the effectiveness of acupuncture in the treatment of frozen shoulder, researchers note, “Acupuncture could be safe and effective for pain reduction, restoring shoulder function, and restoring flexion range of motion for frozen shoulder patients in the short term and midterm.” On the effectiveness of motion style acupuncture treatment (MSAT) in patients with shoulder disorders, researchers found that MSAT improved the shoulder range of motion compared to the control treatment. In this case, the patient continues to be symptomatic despite prior treatment modalities, including extensive physical therapy and oral medication management. The number of acupuncture sessions for functional improvement is five to six. In this clinical setting, given that current medical literature supports a trial of acupuncture for pain management and functional improvement, an acupuncture trial of six sessions for the patient’s left shoulder pain is medically indicated. Therefore, acupuncture is medically necessary for the treatment of this patient. Final Result: The reviewer determined that the requested service is medically necessary for treatment of the patient’s medical condition. Therefore, the Health Plan’s denial should be overturned. Credentials/Qualifications: The reviewer is a licensed L.Ac., board certified in oriental medicine and acupuncture, and is actively practicing. The reviewer is an expert in the treatment of the enrollee’s medical condition and knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.

   Case MN24-42103

8. Upheld 2024 · Medical necessity · age 0–10 Other · Child health The physician reviewer found that Nature of Statutory Criteria/Case Summary: The parents of the patient requested authorization and coverage for oral immunotherapy utilizing the Tolerance Induction Program™ of food allergy treatment (including office visits…

   The physician reviewer found that Nature of Statutory Criteria/Case Summary: The parents of the patient requested authorization and coverage for oral immunotherapy utilizing the Tolerance Induction Program™ of food allergy treatment (including office visits, lab work, and telephone or video visits).The parents of the patient have requested treatment with the Tolerance Induction Program™ (TIP) to help address the patient’s food allergies. The TIP is a form of oral immunotherapy (OIT) that is still in the early stages of development, and further investigations are necessary to optimize the protocols and improve safety. Oral immunotherapy is associated with a higher rate of systemic adverse events compared with other forms of immunotherapy, as well as a risk of eosinophilic esophagitis. The authors of a study indicated that the potential therapeutic benefits of OIT must be carefully considered in light of the significant potential for adverse events, including oropharyngeal, respiratory, or gastrointestinal symptoms. Further, the Researchers’ do not currently recommend OIT as a treatment for patients with food allergies due to the uncertainty as to whether the potential therapeutic benefits outweigh the risks of treatment. Although there are studies that have reported positive outcomes, according to the Researchers, the interventions and endpoints used in clinical trials are too inconsistent to establish the appropriateness of OIT. Thus, the requested oral immunotherapy utilizing the Tolerance Induction Program™ of food allergy treatment (including office visits, lab work, and telephone or video visits) is not medically necessary for the treatment of the patient. Final Result: The reviewer determined that the requested services are not medically necessary for the treatment of the patient’s medical condition. Therefore, the Health Plan’s denial should be upheld. Credentials/Qualifications: The reviewer is board-certified in allergy and immunology and is actively practicing. The reviewer is an expert in the treatment of the enrollee’s medical condition and knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition

   Case MN24-41931

9. Overturned 2022 · Medical necessity · age 21–30 Biofeedback · Digestive system Nature of Statutory Criteria/Case Summary: The patient has requested authorization and coverage for pelvic floor program consisting of (rectal balloon biofeedback therapy) three times a day for one week, and twice a day for a second week. The records document…

   Nature of Statutory Criteria/Case Summary: The patient has requested authorization and coverage for pelvic floor program consisting of (rectal balloon biofeedback therapy) three times a day for one week, and twice a day for a second week. The records document that this patient presents with pelvic dyssynergia and possible anal fistula. Treatment has included surgery, but the patient reports continued symptoms. As noted in the medical literature, symptomatic constipation, anorectal inflammation, and pelvic dyssynergia may require surgery when scarring renders Botox and pelvic floor therapy ineffective. Once diagnostic evaluation reveals no anatomic impediment to biofeedback and medical management, this is considered the mainstay of treatment for this patient population. Mazor and colleagues assessed 138 patients with chronic constipation and symptoms of functional defecatory disorder who were treated with biofeedback. The authors concluded that following biofeedback, “89% of patients in the high group reduced their rectal pressure to normal.” Parker and colleagues found that the overall response rate with biofeedback in patients with chronic constipation and fecal incontinence secondary to pelvic floor neuromuscular sensory or motor dysfunction was 76.2%. Given this support, the requested pelvic floor program consisting of (rectal balloon biofeedback therapy) three times a day for one week, and twice a day for a second week is medically necessary for treatment of this patient. Final Result: The reviewer determined that the requested services are medically necessary for treatment of the patient’s medical condition. Therefore, the Health Plan’s denial should be overturned. Credentials/Qualifications: The reviewer is board certified in urology and is actively practicing. The reviewer is an expert in the treatment of the enrollee’s medical condition and knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.

   Case MN22-37663

10. Overturned 2022 · Medical necessity · age 51–64 Acupuncture · Ear, nose and throat The physician reviewer found that The patient has requested authorization and coverage for acupuncture services. While conventional medicine has not yet developed effective treatments or clinical practice guidelines for the treatment of long COVID-19 due to…

    The physician reviewer found that The patient has requested authorization and coverage for acupuncture services. While conventional medicine has not yet developed effective treatments or clinical practice guidelines for the treatment of long COVID-19 due to the new and evolving nature of the condition and limited number of cases, current medical literature does support the use of acupuncture for the treatment of similar symptoms. Morehead and Salmon note that the efficacy of acupuncture has been proven for nausea and vomiting related to pregnancy, in patients receiving chemotherapy, and in postoperative, pediatric, and female patients. Streitberger reports that results from 26 trials showed that acupuncture-point stimulation was effective for both postoperative nausea and vomiting, concluding that there is good clinical evidence from more than 40 randomized controlled trials that acupuncture has some effect in preventing or attenuating nausea and vomiting. In this case, the patient underwent several therapies with limited relief of her symptoms including oral medication, patches, and vestibular therapy. Following five sessions of acupuncture, the patient reported significant improvement in sense of smell, dizziness, and nausea, allowing for a reduction in medication usage. In this clinical setting, given the patient’s benefits obtained with prior acupuncture care and the literature support for the use of acupuncture to treat nausea, the requested services are medically indicated. Therefore, acupuncture services are medically necessary for the treatment of this patient. Final Result: The reviewer determined that the requested services are medically necessary for treatment of the patient’s medical condition. Therefore, the Health Plan’s denial should be overturned.

    Case MN22-37533

11. Overturned 2022 · Medical necessity · age 21–30 Acupuncture · Digestive system Nature of Statutory Criteria/Case Summary: The patient has requested authorization and coverage for weekly acupuncture for two to three months. On review of the available documentation, this patient presents with interstitial cystitis. The patient has…

    Nature of Statutory Criteria/Case Summary: The patient has requested authorization and coverage for weekly acupuncture for two to three months. On review of the available documentation, this patient presents with interstitial cystitis. The patient has undergone treatment with physical therapy, medications, as well as modifications in her diet without adequate relief of her symptoms. The patient’s provider has recommended treatment with acupuncture. The current peer-reviewed medical literature supports a trial of acupuncture to address this patient’s interstitial cystitis. Medical literatures reported that, “Therapies with the potential for benefit in patients with bladder pain syndrome are dietary management, acupuncture and physical therapy.” The authors noted that complementary alternative medicines for patients with interstitial cystitis can include acupuncture. Researchers found that the results of their study support that acupuncture is an effective, useful, non-invasive method in patients with interstitial cystitis. In reviewing the available documentation, the records do not indicate that the patient has undergone an acupuncture trial. Given the patient’s pain levels despite prior treatment modalities, an acupuncture trial for pain management and function improvement is appropriate. Overall, the medical literature supports treatment with acupuncture for 12 once weekly sessions given this patient’s diagnosis of interstitial cystitis. For these reasons, the requested once weekly acupuncture for three months is medically necessary for treatment of this patient. Final Result: The reviewer determined that the requested services are medically necessary for treatment of the patient’s medical condition. Therefore, the Health Plan’s denial should be overturned. Credentials/Qualifications: The reviewer is a licensed L.Ac., board certified in oriental medicine and acupuncture, and is actively practicing. The reviewer is an expert in the treatment of the enrollee’s medical condition and knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.

    Case MN22-37202

12. Overturned 2022 · Medical necessity · age 41–50 Biofeedback · Injury Nature of Statutory Criteria/Case Summary: The patient has requested authorization and coverage for LORETA neurofeedback therapy two to three times per week for six months. The records provided for review document that this patient has a history of traumatic…

    Nature of Statutory Criteria/Case Summary: The patient has requested authorization and coverage for LORETA neurofeedback therapy two to three times per week for six months. The records provided for review document that this patient has a history of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) with problems in memory, concentration, and hyperarousal symptoms due to traumatic cues associated with his assault. The patient has a complex psychiatric and neurological presentation. He has been treated with various psychotherapeutic and psychopharmacological approaches without substantial improvement. The best outcome for the patient’s psychiatric and neurological symptoms has been from LORETA neurofeedback. As noted in the medical literature, one of the best indicators for future benefit in a patient is past positive response to a treatment modality. In addition, systematic reviews report low risk and high value patient health outcomes with neurofeedback in the treatment of patients with TBI and PTSD (Reiter, et al.; Panisch and Hai). For these reasons, the requested LORETA neurofeedback therapy two to three times per week for six months is medically necessary for treatment of this patient. Final Result: The reviewer determined that the requested services are medically necessary for treatment of the patient’s medical condition. Therefore, the Health Plan’s denial should be overturned. Credentials/Qualifications: The reviewer is board certified in psychiatry and is actively practicing. The reviewer is an expert in the treatment of the enrollee’s medical condition and knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.

    Case MN22-36916