Claim Payment Policy

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Title:

Alternative Therapies and Complementary Medicine

Policy #:

12.00.03

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Application of Claim Payment Policy is determined by benefits and contracts. Benefits may vary based on product line, group or contract. Medical necessity determination applies only if the benefit exists and no contract exclusions are applicable. Individual member benefits must be verified. In products where members are able to self-refer to providers for care and services, members are advised to use participating providers in order to receive the highest level of benefits. For more information on how Claim Payment Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.

Intent

The intent of this policy is to communicate the Company's coverage and reimbursement positions for alternative therapies and complementary medicine. For information on policies related to this topic, refer to the Cross References Table in this policy.

Description

The National Center for Complementary and Alternative Medicine (NCCAM) defines complementary and alternative medicine as a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Conventional medicine is defined as medicine practiced by holders of medical doctor (M.D.) or doctor of osteopathy (D.O.) degrees and by allied health professionals, such as physical therapists, psychologists, and registered nurses. Conventional medicine commonly utilizes clinical studies, clinical trials, and peer-reviewed literature to help determine efficacy and safety. Complementary and alternative medicine is generally not supported by clinical evidence, and its effectiveness and safety is unproven in medical literature. NCCAM categorizes complementary medicine and alternative therapies as follows: Alternative systems of medical practice is the use of medicine from another culture (eg, Ayurveda, Chinese medicine). Bioelectromagnetic therapies is the use of electrical currents or magnetic fields to promote healing (eg, bone repair, electroacupuncture). Diet and nutrition is the use of specific foods, vitamins, and minerals to prevent illness and to treat disease. Herbal medicine is the use of plants as medicine. Manual healing methods is the use of the hands to promote healing (eg, massage, craniosacral therapy). Mind-body interventions is the use of the mind to enhance health (eg, hypnosis, meditation, yoga). Pharmacologic and biologic treatments is the use of various substances (eg, drugs, serums) to treat specific medical problems.

Policy

Alternative therapies and complementary medicine are standard benefit contract exclusions for most of the Company's products and are not eligible for reimbursement consideration. When an alternative therapy is elected as a group option, coverage is dictated by the terms of the rider purchased by the group. Therefore, individual benefits must be verified, as coverage may vary between groups and products. Below is a list of commonly used alternative therapies/complementary medicine (not all-inclusive):

Active release technique Acupressure Acupuncture (refer to the Guidelines section of this policy) Alexander technique AMMA Therapy® Antineoplaston therapy Apitherapy Applied kinesiology (AK) Aromatherapy Art therapy Auto-urine therapy Ayurveda Bilberry Bioenergetic therapy Biofield CanCell (Entelev) therapeutics Bioidentical hormones Black cohosh Bovine cartilage products Cat’s claw Cellular therapy Chinese medicine Chung Moo Doe therapy Coley's toxin Colonic irrigation Conceptual mind-body techniques Coriolus versicolor Craniosacral therapy Crystal healing Cupping Dance/movement therapy Digital myography Ear candling Echinacea Educational therapy Egoscue method Electrodiagnosis (EAV) Electromagnetic fields Equestrian therapy Essential metabolics analysis (EMA) Essiac Faith healing Feldenkrais therapy Flower essences Functional intracellular analysis Gemstone therapy Gerson therapy Ginkgo biloba Greek cancer cure Guided imagery, interactive Hair analysis Hellerwork Hippotherapy Homeopathy Hoxsey method Humor therapy

Hydrazine sulfate therapy Hydrogen peroxide, intravenous Hyperoxygen therapy Hypnotherapy Immunoaugmentive therapy Infratronic Qigong machine Inversion therapy Iridology Kelley/Gonzales therapy Laetrile Live blood cell analysis Lorenzo’s oil Macrobiotics Magnet therapy Massage therapy (refer to the Guidelines section of this policy) Meditation/Transcendental Meditation (TM®) Megavitamin therapy Meridian therapy Millimeter wave therapy Mistletoe (Iscador®) Moxibustion therapy MTH-68 vaccine Music therapy Myotherapy Naturopathy Neural therapy Ozone therapy Pfrimmer deep muscle therapy Polarity therapy Primal therapy Psychodrama Purging Qigong longevity exercises Ream's testing Recreational therapy Reflexology (zone therapy) Reiki Remedial massage Revici's guided chemotherapy Rolfing (structural integration) Rubenfeld synergy method (RSM) Sarapin injections Saw palmetto Seven-fourteen X (714-X) Shark cartilage products Sleep therapy St. John’s wort Therapeutic eurythmy-movement therapy Therapeutic touch Thought field therapy (TFT) Trager body work Wilderness therapy Wurn technique/Clear Passage Therapy® Yoga Yohimbe

REQUIRED DOCUMENTATION The individual's medical record must reflect the medical necessity for the service provided. These medical records may include, but are not limited to, records from the physician's office, hospital, nursing home, home health agencies, therapies, other health care professionals, and test reports. The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request.

Guidelines

MEDICARE This policy is consistent with Medicare's noncoverage of alternative therapies and complementary medicine services. BENEFIT APPLICATION Subject to the terms and conditions of the applicable benefit contract, alternative therapies and complementary medicine are a benefit contract exclusion for most of the Company’s products. Acupuncture, an alternative therapy/complementary medicine service, is considered a benefit contract exclusion for most Company products and groups with the following exception: When acupuncture is elected as a group option, coverage is dictated by the terms of the rider purchased by the group. Therefore, individual benefits must be verified, as coverage may vary between groups and products. Massage therapy, an alternative therapy/complementary medicine service, is considered a benefit contract exclusion for most Company products and groups with the following exception: Therapeutic massage is a covered service when it is provided by an eligible provider. Therapeutic massage is a medically prescribed treatment for physical disabilities or impairments resulting from disease, injury, or congenital anomaly. Therapeutic massage is performed in conjunction with other treatment interventions or modalities and can be rendered by eligible allied health professionals who are defined as such in the respective benefit contracts.

References

American Art Therapy Association. About art therapy. [American Art Therapy Association Web site]. Available at: http://www.arttherapy.org/therapy.asp. Accessed August 11, 2008. Centers for Medicare & Medicaid Services (CMS). National Coverage Determinations Manual.30: Complementary and alternative medicine. [CMS Web site]. 10/03/03. Available at: http://www.cms.hhs.gov/manuals/downloads/ncd103c1_Part1.pdf. Accessed August 14, 2008. Company benefit contracts. International Institute for Bioenergetic Analysis (IIBA). Bioenergetic analysis. [IIBA Web site]. Available at: http://www.bioenergetic-therapy.com. Accessed July 29, 2008. National Center for Complementary and Alternative Medicine (NCCAM). What is complementary and alternative medicine? [NCCAM Web site]. February, 2007. Available at: http://nccam.nih.gov/health/whatiscam/. Accessed July 29, 2008. Qigong Association of America. FAQ: What is Qigong? [Qigong Association of America Web site]. 06/20/07. Available at: http://qi.org/index.php?option=com_content&task=view&id=17&Itemid=43. Accessed July 29, 2008. Rolf Institute of Structural Integration. About rolfing. [Rolf Institute of Structural Integration Web site]. Available at: http://www.rolf.org/about/index.htm. Accessed July 29, 2008. The Rubenfeld Center. What is the Rubenfeld synergy method? [Rubenfeld Synergy Method Web site]. Available at: http://www.rubenfeldsynergy.com/02rsm_0.htm. Accessed July 29, 2008.

Coding Table

Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply. The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates. In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

Code System	Code Number(s) and Narrative(s)
CPT	90880, 97810, 97811, 97813, 97814
ICD Procedure	N/A
ICD Diagnosis	N/A
HCPCS Level II	G0176: Activity therapy, such as music, dance, art or play therapies not for recreation, related to the care and treatment of patient's disabling mental health problems, per session (45 minutes or more) J3570: Laetrile, amygdalin, vitamin B-17 M0075: Cellular therapy S8940: Equestrian/hippotherapy, per session
Revenue Codes	2100: General Classification Alternative Therapy Services 2101: Acupuncture 2102: Acupressure 2103: Massage 2104: Reflexology 2106: Hypnosis 2109: Other Alternative Therapy Services

Cross References

Version Effective Date: 12/20/2006