Notification



Notification Issue Date:



Claim Payment Policy


Title:Complementary and Integrative Health Services

Policy #:12.00.03f

This policy is applicable to the Company’s commercial products only. Policies that are applicable to the Company’s Medicare Advantage products are accessible via a separate Medicare Advantage policy database.

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.When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.

For more information on how Claim Payment Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.



Policy

Coverage is subject to the terms, conditions, and limitations of the member's contract.

Complementary and integrative health services (alternative therapies and complementary medicine) are standard benefit contract exclusions for most of the Company's products and are not eligible for reimbursement consideration.

For information regarding acupuncture, please refer to medical policy 12.00.01, Acupuncture.

When a specific complementary and integrative health service (alternative therapy and complementary medicine) 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.

The following are examples of complementary and integrative health services (alternative therapies and complementary medicine). This list is not all-inclusive.

  • Active release technique
  • Acupressure
  • 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
  • Deep breathing exercises
  • Digital myography
  • Ear candling
  • Echinacea
  • Educational therapy
  • Egoscue method
  • Electrodiagnosis (EAV)
  • Electromagnetic fields
  • Electrosleep therapy
  • 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
  • Herbal medicine/botanicals
  • Hellerwork
  • Hippotherapy
  • Homeopathy
  • Hoxsey method
  • Humor therapy
  • Hydrazine sulfate therapy
  • Hydrogen peroxide, intravenous
  • Hyperoxygen therapy
  • Hypnotherapy
  • Immunoaugmentive therapy
  • Infratronic Qigong therapy
  • Intravenous histamine therapy
  • Inversion therapy
  • Iridology
  • Kelley/Gonzales therapy
  • Laetrile
  • Light therapy
  • 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
  • Pilates
  • Polarity therapy
  • Primal therapy
  • Progressive relaxation
  • Psychodrama
  • Purging
  • Qigong longevity exercises
  • Ream's testing
  • Recreational therapy
  • Reflexology (zone therapy)
  • Reiki
  • Red yeast rice
  • 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
  • Tai chi
  • Therapeutic eurythmy-movement therapy
  • Therapeutic touch
  • Thermogenic therapy
  • Thought field therapy (TFT)
  • Thunder God Vine
  • Trager body work
  • Transillumination light scanning, or Diaphanography
  • Wilderness therapy
  • Wurn technique/Clear Passage Therapy®
  • Yoga
  • Yohimbe

REQUIRED DOCUMENTATION

The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to, records from the professional provider's office, hospital, nursing home, home health agencies, therapies, 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. Failure to produce the requested information may result in a denial for the service.
Guidelines

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable benefit contract, complementary and integrative health services (alternative therapies and complementary medicine) are a benefit contract exclusion for most of the Company’s products.

Massage therapy, a complementary and integrative health service (alternative therapy and complementary medicine), 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.

Description

The National Center for Complementary and Integrative Health (NCCIH), formerly the National Center for Complementary and Alternative Medicine (NCCAM), is the Federal Government's lead agency for scientific research on the diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine. The mission of the NCCIH is to define, through rigorous scientific investigation, the usefulness and safety of complementary and integrative interventions and to provide the public with research-based information to guide healthcare decision making.

Conventional medicine is defined as medicine practiced by holders of medical doctor (MD) or doctor of osteopathy (DO) 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.

Large population-based surveys have found that the use of alternative medicine (i.e., unproven practices used in place of conventional medicine) is rare. Integrative health care, defined as a comprehensive, often interdisciplinary approach to treatment, prevention, and health promotion that brings together complementary and conventional medicine, is more common. The intent of an integrative approach is to enhance overall health, prevent disease, and alleviate debilitating symptoms such as pain and stress and anxiety management that often affects individuals coping with complex and chronic disease, among others. However, unlike conventional medicine which relies upon carefully designed trials and research, the scientific foundation for many complementary health approaches are generally not supported by clinical evidence because their effectiveness and safety is unproven in medical literature.

The NCCIH classifies complementary health approaches not considered an integral part of conventional medicine into the five broad categories described below:
  • Alternative medical systems (e.g., homeopathy, naturopathy, Ayurveda, traditional Chinese medicine).
  • Mind-body interventions: A variety of techniques designed to enhance the mind's capacity to affect bodily function and symptoms (e.g., meditation, prayer, mental healing, and therapies that use creative outlets such as art, music, or dance).
  • Biologically based therapies: The use of natural substances such as herbs, foods, vitamins, or nutritional supplements to prevent and treat illness (e.g., macrobiotics, megavitamin therapy).
  • Manipulative and body-based methods (e.g., massage, equestrian/hippotherapy).
  • Energy therapies: Therapies involving the use of energy fields. They are of two types:
    • Biofield therapies: Therapies that are intended to affect energy fields that some claim surround and penetrate the human body. This includes forms of energy therapy that manipulate biofields by applying pressure and/or manipulating the body by placing the hands in, or through, these fields (e.g., Qi Gong, Reiki, and therapeutic touch).
    • Bioelectromagnetic-based therapies: Therapies involving the unconventional use of electromagnetic fields (e.g., pulsed fields, magnetic fields, or alternating-current or direct-current fields).

References


American Art Therapy Association. About art therapy. [American Art Therapy Association Web site]. Available at: http://www.arttherapy.org/. Accessed July 26, 2018.

Centers for Medicare & Medicaid Services (CMS). National Coverage Determinations Manual.30: Complementary and alternative medicine. [CMS Web site]. 04/03/2018. Available at: http://www.cms.hhs.gov/manuals/downloads/ncd103c1_Part1.pdf. Accessed July 26, 2018.

Company Benefit Contracts.

National Center for Complementary and Integrative Health (NCCIH). 2016 strategic plan. Exploring the science of complementary and integrative health. [NCCIH Web site]. June 2016. Available at:
https://nccih.nih.gov/sites/nccam.nih.gov/files/NCCIH_2016_Strategic_Plan.pdf. Accessed July 26, 2018.

National Center for Complementary and Integrative Health (NCCIH). Complementary, alternative, or integrative health: What's in a name? [NCCIH Web site]. 06/28/2016. Available at: https://nccih.nih.gov/health/integrative-health. Accessed July 26, 2018.

National Institutes of Health (NIH) Almanac. National Center for Complementary and Integrative Health (NCCIH). Mission. [NIH Web site]. 03/17/2016. Available at:
https://www.nih.gov/about-nih/what-we-do/nih-almanac/national-center-complementary-integrative-health-nccih. Accessed July 26, 2018.

National Center for Complementary and Integrative Health (NCCIH). Frequently Asked Questions: Name Change. [NCCIH Web site]. 12/17/2014. Available at:
https://nccih.nih.gov/news/name-change-faq. Accessed July 26, 2018.

National Institutes of Health (NIH). News releases. NIH complementary and integrative health agency gets new name. [NIH Web site]. 12/17/2014. Available at:
https://www.nih.gov/news-events/news-releases/nih-complementary-integrative-health-agency-gets-new-name. Accessed July 26, 2018.

Qigong Association of America. FAQ: What is Qigong? [Qigong Association of America Web site]. 02/05/15. Available at: http://qi.org/index.php?option=com_content&task=view&id=17&Itemid=43. Accessed July 26, 2018.

Rolf Institute of Structural Integration. [Rolf Institute of Structural Integration Web site]. 2018. Available at: http://www.rolf.org/. Accessed July 26, 2018.

Tabish SA. Complementary and Alternative Healthcare: Is it Evidence-based? International Journal of Health Sciences. 2008;2(1):V-IX. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068720/ Accessed July 26, 2018.

US Department of Health and Human Services. NIH National Center for Complementary and Integrative Health - NCCIH. Online resources. [healthfinder.gov Web site]. 10/05/2015. Available at:https://healthfinder.gov/FindServices/Organizations/Organization.aspx?code=hr2549. Accessed July 26, 2018.

World Health Organization. Electromagnetic Fields. [WHO Web site]. 2015. Available at: http://www.who.int/peh-emf/en/ Accessed July 26, 2018.




Coding

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.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.

CPT Procedure Code Number(s)

90880


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD-10 Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD-10 Diagnosis Code Number(s)

N/A


HCPCS Level II Code Number(s)



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 Code Number(s)



1006 Outdoor/wilderness behavioral healthcare

2100 General Classification Alternative Therapy Services

2102 Acupressure

2103 Massage

2104 Reflexology

2106 Hypnosis

2109 Other Alternative Therapy Services

Coding and Billing Requirements


Cross References


Policy History

Revisions 12.00.03f:
01/01/2019This version of the policy will become effective 01/01/2019.

This version provides a reference to the medical policy regarding acupuncture.


Effective 10/05/2017 this policy has been updated to the new policy template format.


Version Effective Date: 01/01/2019
Version Issued Date: 12/31/2018
Version Reissued Date: N/A

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