National Medical Policy

Subject:

Acupuncture

Policy Number:

NMP33

Effective Date*:

October 2003

Updated:

October 2014

This National Medical Policy is subject to the terms in the

IMPORTANT NOTICE
at the end of this document
For Medicaid Plans: Please refer to the appropriate Medicaid Manuals for
coverage guidelines prior to applying Health Net Medical Policies
The Centers for Medicare & Medicaid Services (CMS)
For Medicare Advantage members please refer to the following for coverage
guidelines first:
Use
X

Source
National Coverage Determination
(NCD)

Reference/Website Link
Acupuncture (30.3):
http://www.cms.gov/medicare-coveragedatabase/search/advanced-search.aspx
Acupuncture for Fibromylagia (30.3.1):
http://www.cms.gov/medicare-coveragedatabase/search/advanced-search.aspx
Acupuncture for Osteoarthritis (30.3.2):
http://www.cms.gov/medicare-coveragedatabase/search/advanced-search.aspx
Inpatient Hospital Pain Rehabilitation Programs
(10.3)
http://www.cms.gov/medicare-coveragedatabase/search/advanced-search.aspx
Outpatient Hospital Pain Rehabilitation Programs
(10.4):
http://www.cms.gov/medicare-coveragedatabase/search/advanced-search.aspx

Acupuncture Oct 14

National Coverage Manual Citation

X

Local Coverage Determination

(LCD)*
Article (Local)*
Other
None

Non Covered Services:

http://www.cms.gov/medicare-coveragedatabase/search/advanced-search.aspx

Use Health Net Policy

Instructions
Medicare NCDs and National Coverage Manuals apply to ALL Medicare members
in ALL regions.
Medicare LCDs and Articles apply to members in specific regions. To access your
specific region, select the link provided under Reference/Website and follow the
search instructions. Enter the topic and your specific state to find the coverage
determinations for your region. *Note: Health Net must follow local coverage
determinations (LCDs) of Medicare Administration Contractors (MACs) located
outside their service area when those MACs have exclusive coverage of an item
or service. (CMS Manual Chapter 4 Section 90.2)
If more than one source is checked, you need to access all sources as, on
occasion, an LCD or article contains additional coverage information than
contained in the NCD or National Coverage Manual.
If there is no NCD, National Coverage Manual or region specific LCD/Article,
follow the Health Net Hierarchy of Medical Resources for guidance.

Current Policy Statement

Please refer to the applicable benefit plan document to determine benefit
availability and the terms, conditions and limitations of coverage for
acupuncture
Health Net, Inc. considers acupuncture (manual or electroacupuncture) medically
necessary for any of the following indications:
1.
2.
3.
4.

Chronic low back pain; or

Chronic pain associated with osteoarthritis as adjuvant therapy; or
Nausea & vomiting associated post-operative procedures, chemotherapy or
pregnancy; or
Migraine headache.

Investigational
Health Net, Inc. considers acupuncture investigational for all other indications,
including but not limited to any of the following conditions, because although studies
are still being done, there is inadequate scientific peer-reviewed research assessing
the safety, efficacy and long-term outcomes of acupuncture compared with other
modalities of treatment in these conditions:

Addiction
AIDS
Asthma
Acute low back pain
Carpal tunnel syndrome

Acupuncture Oct 14

Fetal breech presentation

Fibromyalgia
Glaucoma
Hot flashes
Hypertension
Induction of labor
Infertility
Insomnia
Irritable bowel syndrome
Maintenance treatment, where the patients pain symptoms are not improving
Menstrual cramps/dysmenorrhea
Myofascial pain
Neck pain/cervical spondylosis
Obesity
Parkinson's disease
Post-herpetic neuralgia
Psoriasis
Psychiatric disorders (e.g., depression)
Rhinitis
Shoulder pain (e.g., bursitis)
Stroke rehabilitation (e.g., dysphagia)
Tension headache
Tinnitus
Urinary incontinence
Xerostomia
Chronic obstructive pulmonary disease (COPD)

Health Net, Inc. considers acupuncture not medically necessary for any of the
following indications, as the available scientifically based data fails to demonstrate
improved patient outcomes in the medical literature:

Cancer-related dyspnea
Chemotherapy-induced leucopenia
Chronic pain syndrome (e.g., RSD, facial pain)
Fibrotic contractures
In lieu of traditional anesthesia
Painful neuropathies
Peripheral arterial disease (e.g., intermittent claudication)
Phantom leg pain
Raynauds disease pain
Rheumatoid arthritis
Sensorineural deafness
Smoking cessation
Tennis elbow/epicondylitis
Weight loss
Whiplash

Codes Related To This Policy

NOTE:
The codes listed in this policy are for reference purposes only. Listing of a code in
this policy does not imply that the service described by this code is a covered or non-

Acupuncture Oct 14

covered health service. Coverage is determined by the benefit documents and

medical necessity criteria. This list of codes may not be all inclusive.
On October 1, 2015, the ICD-9 code sets used to report medical diagnoses and
inpatient procedures will be replaced by ICD-10 code sets. Health Net National
Medical Policies will now include the preliminary ICD-10 codes in preparation for this
transition. Please note that these may not be the final versions of the codes and
that will not be accepted for billing or payment purposes until the October 1, 2015
implementation date.

ICD-9 Codes
List may not be all-inclusive
307.81
Chronic tension-type headache
346.00346.93
Migraine headache
350.1-350.9 Trigeminal neuralgia
643.00Excessive vomiting in pregnancy
643.93
714.0
Osteoarthritis, generalized
715.00715.90
Osteoarthrosis, generalized
722.2
Lumbar disc protrusion
727.00727.01
Synovitis and Tendonitis
729.1
Myalgia and myositis, unspecified
787.01
Nausea with vomiting [postoperative] [chemotherapy-induced]
E933.1
Adverse effect of antineoplastic and immunosuppressive drugs
[chemotherapy-induced nausea and vomiting]

ICD-10 Codes
G43.001G43. 919
G44.201G44.209
G44.301G44.329
G50.0G50.9
M6.9
M15.0M19.93
M51.84M51.9
M6.9
M654.80M65.9
M79.1M79.2
O21.0O21.9
R11.0R11.2

Migraine
Tension type headache
Post traumatic headache
Trigeminal Neualgia
Rheumatoid arthritis, unspecified
Osteoarthritis
Other and unspecified Dorsopathies, not elsewhere classified
Myositis, unspecified
Other synovitis and tenosynovitis
Myalgia, neuralgia and neuritis, unspecified
Excessive vomiting in pregnancy
Nausea and vomiting

Acupuncture Oct 14

CPT Codes
97810
97811
97813
97814

Acupuncture, one or more needles, w/o electric stimulation; initial 15

minutes of personal one-one contact with the patient.
Acupuncture, one or more needles, w/o electric stimulation; each
additional 15 minutes of personal one-one contact with the patient
with re-insertion of needles.
Acupuncture, one or more needles, with electric stimulation; initial 15
minutes of personal one-one contact with the patient.
Acupuncture, one or more needles, with electric stimulation; each
additional 15 minutes of personal one-one contact with the patient,
with re-insertion of the needle(s).

HCPCS Codes
N/A

Scientific Rationale Update November 2014

Acupuncture refers to a family of procedures used to stimulate anatomical points.
Aside from needles, acupuncturists can incorporate manual pressure, electrical
stimulation, magnets, low-power lasers, heat, and ultrasound. Despite this diversity,
the techniques most frequently used and studied are manual manipulation and/or
electrical stimulation of thin, solid, metallic needles inserted into skin.
Electroacupuncture is a form of acupuncture where a small electric current is passed
between pairs of acupuncture needles. It is similar to traditional acupuncture in that
the same points are stimulated during treatment. As with traditional acupuncture,
needles are inserted on specific points along the body. The needles are then attached
to a device that generates continuous electric pulses using small clips. These devices
are used to adjust the frequency and intensity of the impulse being delivered,
depending on the condition being treated. Electroacupuncture uses two needles at
time so that the impulses can pass from one needle to the other.
Zhang et al (2014) investigated the emetic effects and mechanisms involving
serotonin and dopamine of needleless transcutaneous electroacupuncture (TEA) at
Neiguan (PC6) and Jianshi (PC5) on chemotherapy-induced nausea and vomiting in
patients with cancers. Seventy-two patients with chemotherapy were randomly
divided into sham-TEA group (sham-TEA, n = 34) and TEA group (n = 38). TEA was
performed at PC 6 and PC 5 (1 h, bid) in combination with granisetron. Sham-TEA
was delivered at nonacupoints using the same parameters. The authors found that in
the acute phase, the conventional antiemetic therapy using Ondansetron effectively
reduced nausea and vomiting; the addition of TEA did not show any additive effects.
In the delayed phase, however, TEA significantly increased the rate of complete
control (P < 0.01) and reduced the nausea score (P < 0.05), compared with shamTEA. TEA significantly reduced serum levels of 5-HT and dopamine in comparison
with sham-TEA. The authors concluded the results demonstrate that needleless
transcutaneous electroacupuncture at PC6 using a watch-size digital stimulator
improves emesis and reduces nausea in the delayed phase of chemotherapy in
patients with cancers. This antiemetic effect is possibly mediated via mechanisms
involving serotonin and dopamine.

Acupuncture Oct 14

Xu et al (2012) evaluated the effectiveness of transcutaneous electrical acupoint

stimulation (TEAS) at P6 for the prophylaxis of post operative nausea and vomiting
(PONV) in patients undergoing infratentorial craniotomy. In this prospective, blind,
and randomized study, patients received TEAS at P6 on the dominant side starting
30 minutes before the induction of anesthesia and up to 24 hours after surgery or
sham acustimulation at P6. The anesthesia was maintained with
sevoflurane/remifentanil and intermittent fentanyl/cisatracurium. Antiemetics with 4
mg ondansetron and 10 mg dexamethasone were administered intraoperatively.
Data documenting postoperative episodes of nausea and vomiting and the need for
antiemetic rescue (10 mg metoclopramide intramuscularly) were collected. Statistical
analysis was performed using the test. P<0.05 was considered to be significant. Of
the 130 patients enrolled, 119 patients completed the study. The 24-hour cumulative
incidence of vomiting was significantly lower in the TEAS group than in the control
group (22% vs. 41%, P=0.025). The cumulative incidences of nausea at 6 hours
(27% vs. 47%, P=0.019) and 24 hours (33% vs. 58%, P=0.008) after surgery were
also significantly lower in the TEAS group compared with the control group. The
overall requirements of rescue antiemetics were similar between the groups. The
authors concluded perioperative TEAS at P6 may be an effective adjunct to the
standard antiemetic drug therapy for the prevention of PONV after infratentorial
craniotomy.
Yang et al (2009) compared the clinical effects between electroacupuncture at
Zusanli (ST 36) combined with intravenous drip of Granisetron and intravenous drip
of Granisetron only for treatment of nausea and vomiting caused by the
chemotherapy of the malignant tumor. The methods of multicentral, randomized
controlled trial were used, the observation group (127 cases) was treated with
electroacupuncture at Zusanli (ST 36) combined with intravenous drip of
Granisetron, and the control group (119 cases) was treated with intravenous drip of
Granisetron only. The total effective rate of 90.5% in observation group was
superior to that of 84.0% in control group (P < 0.01); the nausea and vomiting
scores of two groups were obviously decreased after treatment (both P < 0.001),
and the decreased degree of the observation group was superior to that of control
group (P < 0.001).
The authors concluded electroacupuncture at Zusanli (ST 36) can significantly
alleviate the symptoms such as nausea and vomiting caused by the chemotherapy of
the patients.
Choo et al (2006) sought to evaluate the efficacy of electroacupuncture in preventing
anthracycline-based chemotherapy-related nausea and emesis refractory to
combination 5HT(3)-antagonist and dexamethasone. Cancer patients with refractory
emesis after their first cycle of doxorubicin-based chemotherapy were accrued into
this study. Electroacupuncture was given during the second cycle of chemotherapy.
Each patient was evaluated for the number of emetic episodes and grade of nausea
within the first 24 hours after chemotherapy and electroacupuncture. Forty-seven of
a total of 317 patients screened were eligible for this study. Of these, 27 patients
agreed to participate. Twenty-six (26; 96.3%) of them had significant reduction in
both nausea grade and episodes of vomiting after electroacupuncture. There was
complete response with no emetic episodes in 37%. Subjectively, 25 (92.6%) of the
total 27 patients believed that acupuncture was an acceptable procedure and was
helpful in reducing emesis. Electroacupuncture was well-tolerated with a median pain
score of 3 of 10. The investigators concluded that electroacupuncture is welltolerated and effective as an adjunct in reducing chemotherapy-related nausea and
emesis.

Acupuncture Oct 14

Inoue et al (2012) studied the effectiveness of electroacupuncture of the spinal nerve

root using a selective spinal nerve block technique for the treatment of lumbar and
lower limb symptoms in patients with lumbar spinal canal stenosis. Subjects were
17 patients with spinal canal stenosis who did not respond to 2 months of general
conservative treatment and conventional acupuncture. Under x-ray fluoroscopy, two
acupuncture needles were inserted as close as possible to the relevant nerve root, as
determined by subjective symptoms and x-ray and MRI findings, and low-frequency
electroacupuncture stimulation was performed (10 Hz, 10 min). Patients received 3-5
once-weekly treatments, and were evaluated immediately before and after each
treatment and 3 months after completion of treatment. After the first nerve root
electroacupuncture stimulation, scores for lumbar and lower limb symptoms
improved significantly (low back pain, p<0.05; lower limb pain, p<0.05; lower limb
dysaesthesia, p<0.01) with some improvement in continuous walking distance.
Symptom scores and continuous walking distance showed further improvement
before the final treatment (p<0.01), and a significant sustained improvement was
observed 3 months after completion of treatment (p<0.01). The authors concluded
lumbar and lower limb symptoms, for which conventional acupuncture and general
conservative treatment had been ineffective, improved significantly during a course
of electroacupuncture to the spinal nerve root, showing sustained improvement even
3 months after completion of treatment. The mechanisms of these effects may
involve activation of the pain inhibition system and improvement of nerve blood flow.
Shankar et al (2011) evaluated the autonomic status and pain profile in chronic low
back pain (LBP) patients and to observe the effect of electro acupuncture therapy.
Chronic LBP patients (n=60) were recruited from a single center. Age and sex
matched healthy volunteers were selected as controls (n=30). LBP patients were
randomly allocated into two study groups - Group A received 10 sittings of
electroacupuncture, on alternate days, at GB and UB points selected for back pain,
while the Group B received a conventional drug therapy in the form of oral
Valdecoxib together with supervised physiotherapy. Controls were assessed once
while the patients were assessed twice, before and after completion of the treatment
program (3 weeks). The autonomic status was studied with non-invasive
cardiovascular autonomic function tests which included E: I ratio, 30:15 ratio,
postural challenge test and sustained handgrip test. Pain intensity was measured
with the visual analogue scale (VAS) and the global perceived effect (GPE).
Statistical analysis was performed using repeated measure's ANOVA with Tukey's
test. Pain patients showed a significantly reduced vagal tone and increased
sympathetic activity as compared to the controls (P<0.05 to P<0.001 in different
variables). Following treatment, both the study groups showed a reduction in vagal
tone together with a decrease in the sympathetic activity. There was also a
considerable relief of pain in both groups, however, the acupuncture group showed a
better response (P<0.01). The authors concluded that there is autonomic
dysfunction in chronic LBP patients. Acupuncture effectively relieves the pain and
improves the autonomic status and hence can be used as an alternative/additive
treatment modality in these cases.
Yeung et al (2003) sought to determine the effect of a series of electro-acupuncture
(EA) treatment in conjunction with exercise on the pain, disability, and functional
improvement scores of patients with chronic LBP in a blinded prospective randomized
controlled study. A total of 52 patients were randomly allocated to an exercise group
(n = 26) or an exercise plus EA group (n = 26) and treated for 12 sessions.
Numerical Rating Scale (NRS), Aberdeen LBP scale, lumbar spinal active range of

Acupuncture Oct 14

movement (AROM), and the isokinetic strength were assessed by a blinded observer.
Repeated measures analysis of variance (R-ANOVA) with factors of group and time
was used to compare the outcomes between the two groups at baseline (before
treatment), immediately after treatment, 1-month follow-up, and 3-month follow-up.
The level of significance was set at p = 0.05. Significantly better scores in the NRS
and Aberdeen LBP scale were found in the exercise plus EA group immediately after
treatment and at 1-month follow-up. Higher scores were also seen at 3-month
follow-up. No significant differences were observed in spinal AROM and isokinetic
trunk concentric strength between the two groups at any stage of follow-up.The
authors concluded the study provides additional data on the potential role of EA in
the treatment of LBP, and indicates that the combination of EA and back exercise
might be an effective option in the treatment of pain and disability associated with
chronic LBP.

Scientific Rationale Update October 2013

Chronic obstructive pulmonary disease (COPD), a common disease characterized by
irreversible airflow limitation, is predicted to be the third leading cause of death
worldwide by 2020. Dyspnea, the most fundamental and debilitating symptom of
COPD, is associated with considerable disease burden, affecting many aspects of
everyday life. The severity of dyspnea generally progresses over time in patients
with COPD, and dyspnea has been found to be predictive of survival in COPD.
Therefore, the management of dyspnea is one of the most important targets in the
treatment of COPD.
There is good evidence to support relief of dyspnea by pulmonary rehabilitation,
although most studies include primarily or exclusively patients with COPD.
Pulmonary rehabilitation includes exercise training, psychosocial support, nutrition
therapy, and self-management strategies, such as diaphragmatic and pursed lip
breathing. Pulmonary rehabilitation may also improve exercise tolerance and
psychological parameters among patients with lung cancer, although results are
preliminary. Pulmonary rehabilitation might not be appropriate for patients with a
short estimated life expectancy.
Acupuncture has been examined as a potential therapy to reduce dyspnea with
mixed results in retrospective studies, case reports and small randomized trials. The
studies have concluded that the evidence is inadequate to recommend acupuncture
as a routine intervention for dyspnea control in patients with COPD. The studies have
been primarily short-term with inadequate determinations of long-term safety or
efficacy.
Ngai et al. (2013) completed a case report on a 74 year old man, admitted to a
hospital after an acute exacerbation of COPD. Treatment consisted of 45 minutes of
transcutaneous electrical nerve stimulation over acupuncture points (Acu-TENS), a
noninvasive intervention that has recently been shown to alleviate dyspnea in
patients with stable chronic obstructive pulmonary disease (COPD). Oxygen
saturation, heart rate, and dyspnea score were measured before, immediately after,
and 45 minutes after Acu-TENS intervention. Other than the physiologic measures,
10mL of venous blood was taken from the cubital vein for assessment of -endorphin
level, white blood cell count, tumor necrosis factor- (TNF-), and C-reactive protein
(CRP) level before and immediately postintervention. Postintervention, improved
oxygen saturation, and reduction in heart rate and dyspneic sensation were observed

Acupuncture Oct 14

accompanied by a raised blood -endorphin level but the level of white blood cell
count, TNF-, and CRP remain unchanged. Application of 45 minutes Acu-TENS
appeared to alleviate symptoms in a patient with AECOPD. The role of adjunctive
Acu-TENS therapy during acute exacerbation of COPD warrants further investigation.
Suzuki et al. (2012) completed a double-blinded randomized, parallel-group,
placebo-controlled trial. Sixty-eight of 111 patients who were diagnosed as having
COPD and were receiving standard medication participated in this RCT (July 1, 2006,
through March 31, 2009). Participants were randomly assigned to traditional
acupuncture (real acupuncture group, n=34) or placebo needling (placebo
acupuncture group, n=34). Both groups received real or placebo needling at the
same acupoints once a week for 12 weeks. The primary end point was the modified
Borg scale score evaluated immediately after the 6-minute walk test. Measurements
were obtained at baseline and after 12 weeks of treatment. After 12 weeks, the Borg
scale score after the 6-minute walk test was significantly better in the real
acupuncture group compared with the placebo acupuncture group (mean [SD]
difference from baseline by analysis of covariance, -3.6 [1.9] vs 0.4 [1.2]; mean
difference between groups by analysis of covariance, -3.58; 95% CI, -4.27 to -2.90).
Patients with COPD who received real acupuncture also experienced improvement in
the 6-minute walk distance during exercise, indicating better exercise tolerance and
reduced DOE. This study notes that acupuncture is a promising adjunctive therapy in
reducing DOE in patients with COPD. However, it was a short-term study only with
follow-up at 12 weeks. Additional studies with long-term follow-up are necessary to
determine if acupuncture really shows improvement in COPD patients over a more
substantial period of time.
Deering et al. (2011) completed a randomized prospective study in which all subjects
had COPD. There were 19 controls, 25 who underwent pulmonary rehabilitation (PR),
and 16 who had both acupuncture and PR. The primary outcome measure was a
change in measures of systemic inflammation at the end of PR and at 3 month
followup. Lung function, including maximum inspiratory pressure (PiMax), quality-oflife scores, functional capacity including steps taken, dyspnea scores, and exercise
capacity, were secondary endpoints. After PR, both groups had significantly improved
quality-of-life scores, reduced dyspnea scores, improved exercise capacity, and
PiMax, but no change in measures of systemic inflammation compared with the
controls. There were no differences in most of the outcome measures between the 2
treatment groups except that subjects who had both acupuncture and PR remained
less breathless for a longer period. The addition of acupuncture to PR did not add
significant benefit in most of the outcomes measured. In addition, this was a small
study with a very short follow-up time of only 3 months.
Postion Statements
None of the following societies feel that acupuncture is supported in peer-reviewed
medical literature for the treatment of COPD:

The American Thoracic Society Documents, (2012), An Official American

Thoracic Society Workshop Report on The Integrated Care of the COPD Patient
does not mention acupuncture as a treatment for COPD.

The Global Initiative for Chronic Obstructive Lung Disease (GOLD, 2013) states
that acupuncture for treatment of COPD has not been adequately tested.

Acupuncture Oct 14

The Work Loss Data Institute (WLDI, 2009) states that acupuncture for
treatment of COPD has not been adequately tested.

The Canadian Thoracic Society (CTS, 2011) does not support the routine use of
acupuncture for patients with COPD due to insufficient evidence.

Summary
Although multiple studies have been done to try to determine the efficacy and safety
of acupuncture for the treatment of COPD, and some of the findings were promising,
it has been noted that the majority of studies were small with no long-term
outcomes. Additional larger, peer-reviewed, randomized controlled studies are
necessary to evaluate long-term outcomes in indivuals treated for COPD with
acupuncture.

Scientific Rationale Update October 2012

Cho et al (2012) investigated the efficacy of acupuncture treatment with
individualized setting for reduction of bothersomeness in participants with chronic
low back pain (cLBP) in a multicenter, randomized, patient-assessor blind, shamcontrolled clinical trial. One hundred thirty adults aged 18-65 with non-specific LBP of
lasting for at least the last 3 months was participated in the three Korean medical
hospitals in Korea. Participants got individualized real acupuncture treatments or
sham acupuncture treatments over 6 weeks (twice a week) from Korean medicine
doctors. Primary outcome was change of Visual Analogue Scale (VAS) score for
bothersomeness of cLBP. Secondary outcomes included VAS for pain intensity and
questionnaires including Oswestry disability index (ODI), General health status (SF36), and Beck's depression inventory (BDI).Results. There were no baseline
differences observed between two groups except ODI. One hundred sixteen
participants finished the treatments and 3-, 6-month follow ups with fourteen
subjects' drop-out. Significant difference of VAS for bothersomeness and pain
intensity of cLBP have been found between two groups (p<0.05) at the primary end
point (8 week). In addition, those two scores have been improved continuously until
3-month follow up (p = 0.011, p = 0.005, respectively). ODI, BDI and SF-36 scores
were also improved in both groups without group difference. Investigators concluded
this randomized sham-controlled trial suggests that acupuncture treatment show the
better effects on the reduction of the bothersomeness and pain intensity than shamcontrol in participants with cLBP.
Bokmand and Flyger (2012) evaluated the effect of acupuncture on hot flashes and
disturbed night sleep in patients treated for breast cancer. The effect of acupuncture
was tested against a sham-acupuncture group and a no-treatment control group.
Plasma estradiol was measured to rule out this as cause of effect. Side effects of the
treatment were registered. 94 women were randomized into the study: 31 had
acupuncture, 29 had sham acupuncture and 34 had no treatment. In the
acupuncture group, 16 patients (52%) experienced a significant effect on hot flashes
compared with seven patients (24%) in the sham group (p < 0.05). The effect came
after the second acupuncture session and lasted for at least 12 weeks after last
treatment. A statistically significant positive effect was seen on sleep in the
acupuncture group compared with the sham-acupuncture and no-treatment groups.
The effect was not correlated with increased levels of plasma estradiol. No side
effects of acupuncture were registered. Investigators concluded that acupuncture

Acupuncture Oct 14

10

significantly relieves hot flashes and sleep disturbances and is a good and safe
treatment in women treated for breast cancer. The project is registered at Clinical
Trials.gov (no: NCT00425776).
Gel et al (2012) investigated the effect of acupuncture on weight loss and whether
a brief acupuncture treatment of 5 weeks can change circulating levels of leptin,
ghrelin, insulin and cholecystokinin (CCK) in obese women. 40 women with a body
mass index (BMI)>30 kg/m(2) were equally randomised to either an acupuncture
group or a sham (non-penetrating) acupuncture group and received treatment at
LI4, HT7, ST36, ST44 and SP6 bilaterally. Both groups had two sessions of 20
min/week for a total of 10 sessions. Serum insulin, leptin, plasma ghrelin and CCK
levels were measured by ELISA. Acupuncture treatment decreased insulin and leptin
levels and induced weight loss, together with a decrease in BMI compared with sham
acupuncture. Furthermore, between-group analyses demonstrated increases in
plasma ghrelin and CCK levels in subjects who received acupuncture treatment.
Investigators concluded the findings suggest that acupuncture may help to regulate
weight owing to its beneficial effects on hormones such as insulin, leptin, ghrelin and
CCK in obese subjects even after a few weeks of treatment.

Scientific Rationale Update November 2009

Over the past several decades, the use of complementary and alternative medicine
(CAM) has increased in the general population. Between 1990 and 1997, the
percentage of American patients using alternative therapies grew considerably, from
34 to 42%. Acupuncture is among the CAM therapies most frequently recommended
by internists and family physicians and is currently practiced in over 140 hospitals in
the United States.
Professional Societies
(1997) National Institutes of Health consensus statement concluded that
acupuncture showed promise in adult postoperative and chemotherapy-induced
nausea and vomiting.
(1998) The National Institutes of Health (NIH) Office of Complementary and
Alternative Medicine Consensus Development Statement on acupuncture concluded
that acupuncture is effective in alleviating postoperative and chemotherapy nausea
in adults and may be effective for treating nausea in pregnancy. The NIH Consensus
Statement also concluded that the evidence was promising for the use of
acupuncture in some cases of pain management.
National Comprehensive Cancer Network guidelines recommend nonpharmacological
modalities such as acupuncture if pain scores remain at 4 or above on a 10-point
scale after re-evaluation and modification of pharmacological management. In the
absence of guidelines concerning when and how to incorporate complementary
therapies, decisions should be based on clinical judgment, patient preference, and
the risk/ benefit ratio.
(2003) The U.S. Department of Health and Human Services, Public Health Service,
Agency for Healthcare Research and Quality (AHRQ) recently performed a technology
assessment on Acupuncture for the Treatment of Fibromyalgia; it stated that At this
time, therefore, there is insufficient evidence to conclude that acupuncture has
efficacy for the treatment of fibromyalgia.

Acupuncture Oct 14

11

(2007) The American College of Physicians (ACP) and American Pain Society
developed evidence-based clinical practice guidelines for diagnosing and treating low
back pain in the primary care setting. According to the guideline recommendations,
acupuncture is considered a moderately effective nonpharmacologic therapy for
treating chronic low back pain.
(2008) The American Academy of Orthopedic Surgeons has a section on
complementary and alternative therapy, are unable to recommend for or against the
use of acupuncture as an adjunctive therapy for pain relief in patients with
symptomatic OA of the knee. (Level of Evidence: I, Grade of Recommendation:
Inconclusive).
Chronic Low Back Pain
Deyo et al. (2009) performed a randomized controlled trial called (SPINE)
(Stimulating Points to Investigate Needling Efficacy). 638 adult patients were
included in this study, with patients randomly assigned to 4 groups:

Individualized needle acupuncture, involving a customized prescription for

acupuncture points.
Standardized needle acupuncture, using single prescription for acupuncture
points on back & backs of legs (i.e. generally effective for chronic LBP)
Simulated acupuncture on same standardized points, mimicking needle
acupuncture but instead of needle using toothpick in needle guide tube w/o
penetrating the skin
Standard medical care pts would have gotten. All pts in 3 acupuncture groups
(individualized, standardized, or simulated) were Rx 2x/wkx3wks, 1x/wkx4wks.

All patients in the three acupuncture groups (individualized, standardized, or

simulated) were treated 2x/weekx3weeks, 1x/weekx4weeks. At 8weeks, 6months,
& 1 year, back-related dysfunction was measured, and patients symptoms were
noted. At 8 wks all 3 acupuncture groups were functioning substantially better,
while the group getting only usual care was functioning only slightly better.
Dysfunction scores improved significantly more for all 3 acupuncture groups than for
the usual care group. Benefits lasted for a year, although they waned over time.
Outcomes for groups that received the needle and simulated forms of acupuncture
did not differ significantly. So, although acupuncture effectively treated low back
pain, therapeutic benefit seemed to require neither acupuncture needle sites to
individual patient nor inserting needles into the skin. Simulated acupuncture,
without skin penetration, produced as much benefit as needle acupuncture. The
precise reason why simulated acupuncture relieves low back pain is unknown.
Future research is needed to delve deeper into what is evoking these positive
responses in simulated acupuncture.
Nausea and Vomitting
Since 1997, six studies have demonstrated efficacy for preventing postoperative
nausea and vomiting in children as well. A 2004 Cochrane review of 26 trials
involving 3347 children and adults showed that acupuncture with and without
electrical stimulation and acupressure are effective in decreasing the incidence of
postoperative nausea and vomiting in comparison with controls. When compared,
acupuncture and acupressure are equivalent to antiemetic drugs for preventing
vomiting but are actually better for preventing nausea.
Chronic Pain associated with Osteoarthritis of Knee

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Miller et al. (2009) published the results of a randomized controlled clinical trial
(n=55) assessing the efficacy of acupuncture as an adjunct therapy to standard care
in a group of elderly patients with osteoarthritis of the knee. Primary outcome
measures were changes in Knee Society Score (KSS) and in KSS function and pain
ratings at therapy onset, after eight weeks and at 12 weeks. The authors noted
significant improvements in all scores for both groups at eight weeks and 12 weeks
compared with baseline. Acupuncture had a longer lasting effectsignificant
differences between the intervention group and control group in the KSS was not
noticeable until after 12 weeks (eight weeks of therapy and one month follow-up).
Berman et al. (2004) completed a randomized controlled trial of 570 patients with
osteoarthritis of knee. Twenty-three true acupuncture sessions were done over 26
weeks. Controls received 6 (2 hour) sessions over 12 weeks or 23 sham acupuncture
sessions in 26 weeks. Patients in the true acupuncture group had >improvement in
WOMAC function scores than the sham acupuncture group at 8 weeks. Acupuncture
seems to provide improvement in function and pain relief as an adjunctive therapy
for osteoarthritis of knee when compared with credible sham acupuncture and
education control.
Migraine Headache
Linde et al. (2009) [Cochrane Database] completed a randomized study with two
reviewers. A post-randomization observation period of at least 8 weeks that
compared the clinical effects of an acupuncture intervention with a control (no
prophylactic treatment or routine care only), a sham acupuncture intervention or
another intervention in patients with migraine. Twenty-two trials with 4419
participants (mean 201, median 42, range 27 to 1715) met the inclusion criteria. Six
trials (including two large trials with 401 and 1715 patients) compared acupuncture
to no prophylactic treatment or routine care only. After 3 to 4 months patients
receiving acupuncture had higher response rates and fewer headaches. The only
study with long-term follow up saw no evidence that effects dissipated up to 9
months after cessation of treatment. Fourteen trials compared a 'true' acupuncture
intervention with a variety of sham interventions. Pooled analyses did not show a
statistically significant superiority for true acupuncture for any outcome in any of the
time windows, but the results of single trials varied considerably. Four trials
compared acupuncture to proven prophylactic drug treatment. Overall in these trials
acupuncture was associated with slightly better outcomes and fewer adverse effects
than prophylactic drug treatment. In the previous version of this review, evidence in
support of acupuncture for migraine prophylaxis was considered promising but
insufficient. Now, with 12 additional trials, there is consistent evidence that
acupuncture provides additional benefit to treatment of acute migraine attacks only
or to routine care. Available studies suggest that acupuncture is at least as effective
as, or possibly more effective than, prophylactic drug treatment, and has fewer
adverse effects. Acupuncture should be considered a treatment option for patients
willing to undergo this treatment.
NOTE: The following are general guidelines that may help to guide the frequency
and duration of acupuncture visits, depending on the severity of the various
conditions that the individual may have:

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Stage of Condition
Chronic (Pain/Migraine)
Recurrent (Pain/Migraine)
Nausea/Vomitting

Frequency
3x week
3x week
3-5x week

Duration
4 weeks
4 weeks
3 weeks

Re-evaluate After
12 Treatments
12 Treatments
15 Treatments

Acupuncture in Lieu of Anesthesia

There are minimal studies done on acupuncture in lieu of anesthesia. Some
acupuncturists are doing this as part of their practice, however, there is no evidencebased peer-reviewed studies to support this practice.
CMS Centers for Medicare & Medicaid
NCD for Acupuncture (30.3)
Until the pending scientific assessment of the technique has been completed and its
efficacy has been established, Medicare reimbursement for acupuncture, as an
anesthetic or as an analgesic or for other therapeutic purposes, may not be made.
Accordingly, acupuncture is not considered reasonable and necessary within the
meaning 1862(a)(1) of the Act.
Fibromyalgia (NCD for Acupuncture for Fibromyalgia (30.3.1)
After careful reconsideration of its initial noncoverage determination for acupuncture,
CMS concludes that there is no convincing evidence for the use of acupuncture for
pain relief in patients with fibromyalgia. Study design flaws presently prohibit
assessing acupunctures utility for improving health outcomes.
Osteoarthritis (NCD for Acupuncture for Osteoarthritis (30.3.2)
After careful reconsideration of its initial noncoverage determination for acupuncture,
CMS concludes that there is no convincing evidence for the use of acupuncture for
pain relief in patients with osteoarthritis. Study design flaws presently prohibit
assessing acupunctures utility for improving health outcomes.

Scientific Rationale Initial

Acupuncture is a traditional form of Chinese medical treatment that has been
practiced for over 3000 years. Acupuncture involves piercing the skin with needles at
specific body sites to induce anesthesia, to relieve pain, to alleviate withdrawal
symptoms of substance abusers, or to treat various non-painful disorders (e.g. to
relieve nausea/vomiting). In traditional acupuncture, the placement of needles into
the skin is dictated by the location of meridians. These meridians are thought to
mark patterns of energy flow throughout the human body. The technology has four
components - the acupuncture needle(s), the target location defined by traditional
Chinese medicine, the depth of insertion, and the stimulation of the inserted needle.
The FDA has approved acupuncture needles.
Electroacupuncture (i.e., transcutaneous electrical nerve stimulation (TENS)
acupuncture) is the practice of piercing specific body sites with needles that are
stimulated by an extremely low voltage of electricity.

Review History

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October 16, 2003

April 2006
April 2008
September 2009
October 2009

November 2009
March 2011
November 2011
October 2012
October 2013
October 2014
November 2014

Medical Advisory Council

Update no revisions
Update no revisions. Codes updated.
Policy title changed to Acupuncture
Update. Policy had approved acupuncture for pain.
Added nausea, vomiting, and migraine headaches as
medically necessary. Added Medicare non-coverage.
Codes reviewed.
Revised policy with frequency of visits as advised from
committee members.
Update no revisions
Update no revisions
Update no revisions
Update Added acupuncture as investigational for
COPD. Codes updated.
Update no revisions. Codes updated.
Clarified policy statement that acupuncture can be
performed manually or with electoacupuncture.

This policy is based on the following evidence-based guidelines:

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.

Lee A, Fan LTY. Stimulation of the wrist acupuncture point P6 for preventing
postoperative nausea and vomiting. Cochrane Database of Systematic Reviews,
2009, Issue 2.
Linde K, Allais G, Brinkhaus B, et al. Acupuncture for tension-type headache.
Cochrane Database Syst Rev. 2009 Jan 21;(1):CD007587.
American Academy of Orthopaedic Sugeons. Treatment of Osteoarthritis of the
knee (non-arthroplasty). Full Guideline. December 6, 2008. Available at:
http://www.aaos.org/Research/guidelines/guide.asp
Thomas LH, Cross S, Barrett J, et al. Treatment of urinary incontinence after
stroke in adults. Cochrane Database Syst Rev. 2008;(1): CD004462.
Bausewein C, Booth S, Gysels M, et al. Non-pharmacological interventions for
breathlessness in advanced stages of malignant and non-malignant diseases.
Cochrane Database Syst Rev. 2008;(2):CD005623.
Xie Y, Wang L, He J, Wu T. Acupuncture for dysphagia in acute stroke. Cochrane
Database Syst Rev. 2008;(3):CD006076.
Melchart D, Linde K, Fischer P, et al. Acupuncture for idiopathic headache.
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2007. Updated April 15, 2008.
Hayes. Search & Summary. Acupuncture for Chronic Obstructive Pulmonary
Disease (COPD). April 23, 2013.
Hayes. Health Technology Brief. Acupuncture for Treatment of Chronic
Obstructive Pulmonary Disease (COPD). August 5, 2013.
Nici L, ZuWallack R; American Thoracic Society Subcommittee on Integrated
Care of the COPD Patient. An official American Thoracic Society workshop report:
the Integrated Care of The COPD Patient. Proc Am Thorac Soc. 2012;9(1):9-18.
Hayes. Medical Technology Directory. Acupuncture for Assisted Reproduction.
July 15, 2011. Upated June 5, 2014.
Hayes. Medical Technology Directory. Acupuncture for Treatment of Low Back
Pain. October 21, 2010. Updated October 7, 2013.
Hayes. Medical Technology Directory. Acupuncture for Treatment of
Postoperative Pain. May 20, 2009. Updated May 23, 2013. Archived June 20,
2014-09-05

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References Update November 2014

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Wang QP, Bai M, Lei D. Effectiveness of acupuncture in treatment of facial
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Cho SY, Shim SR, Rhee HY, et al. Effectiveness of acupuncture and bee venom
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Smith CA, Crowther CA, Petrucco O, et al. Acupuncture to treat primary
dysmenorrhea in women: a randomized controlled trial. Evid Based Complement
Alternat Med. 2011;2011:612464
Smith CA, Ussher JM, Perz J, et al. The Effect of Acupuncture on Psychosocial
Outcomes for Women Experiencing Infertility: A Pilot Randomized Controlled
Trial. J. Altern Complement Med. 2011 Oct 6
Su JT, Zhou QH, Li R, et al. Immediate analgesic effect of wrist-ankle
acupuncture for acute lumbago: a randomized controlled trial. Zhongguo Zhen
Jiu. 2010 Aug;30(8):617-22
Sun MY, Hsieh CL, Cheng YY, et al. The therapeutic effects of acupuncture on
patients with chronic neck myofascial pain syndrome: a single-blind randomized
controlled trial. Am J Chin Med. 2010;38(5):849-59.
Takayama S, Seki T, Nakazawa T, et al. Short-term effects of acupuncture on
open-angle glaucoma in retrobulbar circulation: additional therapy to standard
medication. Evid Based Complement Alternat Med. 2011;2011:157090
Tong J, Chen JX, Zhang ZQ, et al. Clinical observation on simple obesity treated
by acupuncture. Zhongguo Zhen Jiu. 2011 Aug;31(8):697-701
Ursini T, Tontodonati M, Manzoli L, et al. Acupuncture for the treatment of
severe acute pain in herpes zoster: results of a nested, open-label, randomized
trial in the VZV Pain Study. BMC Complement Altern Med. 2011 Jun 5;11:46
White AR, Rampes H, Liu JP, et al. Acupuncture and related interventions for
smoking cessation. Cochrane Database Syst Rev. 2011 Jan 19;(1):CD000009
Wu F, Kang MF, Xiong P, Xiong J. Clinical randomized controlled trials of
treatment of neck-back myofascial pain syndrome by acupuncture of Ashi-points
combined with moxibustion of heat-sensitive points. Zhen Ci Yan Jiu. 2011
Apr;36(2):116-20
Yang CP, Wang NH, Li TC, et al. A randomized clinical trial of acupuncture
versus oral steroids for carpal tunnel syndrome: a long-term follow-up. Pain.
2011 Feb;12(2):272-9
Zhu X, Hamilton KD, McNicol ED. Acupuncture for pain in endometriosis.
Cochrane Database Syst Rev. 2011 Sep 7;9:CD007864

References Updated March 2011

1.

Coura LE, Manoel CH, Poffo R, et al. Randomised, controlled study of

preoperative eletroacupuncture for postoperative pain control after cardiac
surgery. Acupunct Med. 2011 Mar;29(1):16-20

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2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.

Jung A, Shin BC, Lee MS, Sim H, Ernst E. Acupuncture for treating
temporomandibular joint disorders: A systematic review and meta-analysis of
randomized, sham-controlled trials. J Dent. 2011 Feb 25. [
Kumnerddee W, Kaewtong A. Efficacy of acupuncture versus night splinting for
carpal tunnel syndrome: a randomized clinical trial. J Med Assoc Thai. 2010
Dec;93(12): 1463-9.
Lee MS, Ernst E. Acupuncture for pain: An overview of Cochrane reviews. Chin
J Integr Med. 2011 Mar;17(3):187-9.
Lee SW, Liong ML, Yuen KH, et al. Validation of a sham acupuncture procedure
in a randomised, controlled clinical trial of chronic pelvic pain treatment.
Acupunct Med. 2011 Mar;29(1):40-6.
Liang Z, Zhu X, Yang X, Fu W, Lu A. Assessment of a traditional acupuncture
therapy for chronic neck pain: a pilot randomised controlled study.
Li HJ, Zhong BL, Fan YP, Hu HT. Acupuncture for post-stroke depression: a
randomized controlled trial. Zhongguo Zhen Jiu. 2011 Jan;31(1):3-6
Lin CW, Haas M, Maher CG, et al. Cost-effectiveness of guideline-endorsed
treatments for low back pain: a systematic review. Eur Spine J. 2011 Jan 13
Paley CA, Johnson MI, Tashani OA, Bagnall AM. Acupuncture for cancer pain in
adults. Cochrane Database Syst Rev. 2011 Jan 19;(1):CD007753.
Smith CA, Zhu X, He L, Song J. Acupuncture for primary dysmenorrhoea.
Cochrane Database Syst Rev. 2011 Jan 19;(1):CD007854
Sunay D, Ozdiken M, Arslan H, et al. The effect of acupuncture on
postmenopausal symptoms and reproductive hormones: a sham controlled
clinical trial. Acupunct Med. 2011 Mar;29(1):27-31.
Yang CP, Wang NH, Li TC, et al. A randomized clinical trial of acupuncture
versus oral steroids for carpal tunnel syndrome: a long-term follow-up. J Pain.
2011 Feb;12(2):272-9.
Yeh ML, Chung YC, Chen KM, et al. Acupoint electrical stimulation reduces acute
postoperative pain in surgical patients with patient-controlled analgesia: a
randomized controlled study. Altern Ther Health Med. 2010 Nov-Dec;16(6):108.

References Updated October 2009

1.

2.
3.
4.
5.
6.
7.

Deyo RA, Khalsa PS, Avins AL, et al. Acupuncture eases chronic low back pain in
SPINE trial. Stimulating Points to Investigate Needling Efficacy, (SPINE). The
National Center for Complementary and Alternative Medicine (NCCAM), part of
the National Institutes of Health, funded the SPINE trial. 2009.
Miller E, Maimon Y, Rosenblatt Y, et al. Delayed Effect of Acupuncture Treatment
in OA of the Knee: A Blinded, Randomized, Controlled Trial. Evid Based
Complement Alternat Med. 2009 Jan 5.
Smith CA, Crowther CA, Collins CT, et al. Acupuncture to induce labor: A
randomized controlled trial. Obstet Gynecol. 2008;112(5):1067-1074.
Cheong YC, Hung Yu Ng E, et al. Acupuncture and assisted conception. Cochrane
Database Syst Rev. 2008;(4):CD006920.
El-Toukhy T, Sunkara SK, Khairy M, et al. A systematic review and metaanalysis of acupuncture in in vitro fertilisation. BJOG. 2008;115(10):1203-1213.
Ng EH, So WS, Gao J, et al. The role of acupuncture in the management of
subfertility. Fertil Steril. 2008;90(1):1-13.
Lam YC, Kum WF, Durairajan SS, et al. Efficacy and safety of acupuncture for
idiopathic Parkinson's disease: A systematic review. J Altern Complement Med.
2008;14(6):663-671.

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8.
9.
10.
11.
12.
13.
14.
15.
16.

17.

18.
19.

Ben-Aharon I, Gafter-Gvili A, Paul M, et al. Interventions for alleviating cancerrelated dyspnea: A systematic review. J Clin Oncol. 2008;26(14):2396-2404.
Lee MS, Pittler MH, Shin BC, et al. Bee venom acupuncture for musculoskeletal
pain: A review. J Pain. 2008;9(4):289-297.
Roberts J, Huissoon A, Dretzke J, et al. A systematic review of the clinical
effectiveness of acupuncture for allergic rhinitis. BMC Complement Altern Med.
2008;8:13.
Facco E, Liguori A, Petti F, et al. Traditional acupuncture in migraine: A
controlled, randomized study. Headache. 2008;48(3):398-407
Alecrim-Andrade J, Maciel-Jnior JA, Carn X, et al. Acupuncture in Migraine
Prevention: A Randomized Sham Controlled Study With 6-months Posttreatment
Follow-up. Clin J Pain. 2008 Feb;24(2):98-105.
Yuan J, Purepong N, Kerr DP, Park J, et al. Effectiveness of acupuncture for low
back pain: a systematic review. Spine. 2008 Nov 1;33(23):E887-900.
Sun Y, Gan TJ. Acupuncture for the management of chronic headache: a
systematic review. Anesth Analg. 2008 Dec;107(6):2038-47.
Selfe TK, Taylor AG. Acupuncture and osteoarthritis of the knee: a review of
randomized, controlled trials. Fam Community Health. 2008 Jul-Sep;31(3):24754.
Jubb RW, Tukmachi ES, Jones PW, et al. A blinded randomised trial of
acupuncture (manual and electroacupuncture) compared with a non-penetrating
sham for the symptoms of osteoarthritis of the knee. Acupunct Med. 2008
Jun;26(2):69-78.
Hurwitz EL, Carragee EJ, van der V, et al. Bone and Joint Decade 2000-2010
Task Force on Neck Pain and Its Associated Disorders. Treatment of neck pain:
noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task
Force on Neck Pain and Its Associated Disorders. Spine. 2008 Feb 15;33(4
Suppl):S123-52.
Michelfelder AJ. Acupuncture for Headaches and Acupuncture for Nausea and
Vomiting. Rakel: Integrative Medicine, 2nd ed. 2007 Saunders, An Imprint of
Elsevier.
Berman BM, Lao L, Lange P, et al. Effectiveness of Acupuncture as Adjunctive
Therapy in Osteoarthritis of the Knee. A Randomized, Controlled Trial. Annals of
Internal Medicine. 21 December 2004 | Volume 141 Issue 12 | Pages 901-910.

References Updated April 2008

1.
2.
3.
4.
5.

Lee SWH, Liong ML, Yuen KH, et al. Acupuncture versus Sham Acupuncture for
Chronic Prostatis/Chronic Pelvic Pain. The American Journal of Medicine. Volume
121, Issue I (January 2008)
EE CE, Manheimer E, Pirotta MV, et al. Acupuncture for Pelvic Pain and Back
Pain in Pregnancy. AMERICAN JOURNAL OF OB/ GYN. VOLUME 198. ISSUE 3,
MARCH 2008.
Cherkin DC, Sherman KJ, Hogeboom CJ, et al. Efficacy of acupuncture for
chronic low back pain: protocol for a randomized controlled trial. PubMed
2008 Feb 28;9(1):10.
Tam LS, Leung PC, Li TK, Zhang L, et al. Acupuncture in the treatment of
rheumatoid arthritis: a double blind controlled pilot study. BMC Complement
Altern Med. 2007 Nov 3;7:35.
Brinkhaus B, Witt CM, Jena S, et al. Physician and treatment characteristics in a
randomised multicentre trial of acupuncture in patients with osteoarthritis of the
knee. Complement Ther Med. 2007 Sep;15(3):180-9. Epub 2006 Jun 22.

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6.

Cassileth BR, Deng GE, Gomez JE, et al. Complementary therapies and
integrative oncology in lung cancer: ACCP evidence-based clinical practice
guidelines (2nd edition). Chest. 2007 Sep;132(3 Suppl):340S-354S.

References - Initial
1. Audette JF, Blinder RA. Curr Pain Headache Rep. 2003 Oct;7(5):395-401.
2. Berman BM, Swyers JP, Ezzo J. The Evidence for Acupuncture as a Treatment for
Rheumatologic Conditions. Rheumatic Disease Clinics of North America 2000 Feb;
26(1): 103-15.
3. Chen R, Nickel JC. Acupuncture ameliorates symptoms in men with chronic
prostatitis/chronic pelvic pain syndrome. Urology. 2003 Jun;61(6):1156-9
4. Cummings M. Referred knee pain treated with electroacupuncture to iliopsoas.
Acupunct Med. 2003 Jun;21(1-2):32-5.
5. Guerra J, Bassas E, Andres M, et al. Acupuncture for soft tissue shoulder
disorders: a series of 201 cases. Acupunct Med. 2003 Jun;21(1-2):18-22;
discussion 22
6. Meng CF, Wang D, Ngeow J, et al. Acupuncture for chronic low back pain in older
patients: a randomized, controlled trial. Rheumatology (Oxford). 2003 Jul 30
7. Rabinstein AA, Shulman LM. Acupuncture in clinical neurology. Neurolog. 2003
May;9(3):137-48.
8. Sator-Katzenschlager SM, Szeles JC, Scharbert G, et al. Electrical stimulation of
auricular acupuncture points is more effective than conventional manual auricular
acupuncture in chronic cervical pain: a pilot study. Anesth Analg. 2003
Nov;97(5):1469-73.
9. Smith MJ, Tong HC, Werner RA, Haig AJ. Acupuncture analgesia and
electromyography. Arch Phys Med Rehabil. 2003 Sep;84(9):E1-2.
10. Usichenko TI, Ivashkivsky OI, Gizhko VV. Treatment of rheumatoid arthritis with
electromagnetic millimeter waves applied to acupuncture points--a randomized
double blind clinical study. Acupunct Electrother Res. 2003;28(1-2):11-8.
11. Yeung CK, Leung MC, Chow DH. The use of electro-acupuncture in conjunction
with exercise for the treatment of chronic low-back pain. J Altern Complement
Med. 2003 Aug;9(4):479-90.
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