Commercial

Medical Policy

Title:

Complementary and Integrative Health Services

Policy #:

12.00.03h

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

For information regarding therapeutic massage, please refer to medical policies:

10.02.02 - Chiropractic Spinal and Extraspinal Manipulation Therapy
10.03.01 - Physical Medicine, Rehabilitation, and Habilitation Services

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 nonmainstream 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 affect individuals coping with complex and chronic disease. 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 are 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: https://arttherapy.org/about-art-therapy/. Accessed April 16, 2024.

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 April 16, 2024.

Company Benefit Contracts.

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://www.nccih.nih.gov/health/complementary-alternative-or-integrative-health-whats-in-a-name. Accessed April 16, 2024.

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 April 16, 2024.

National Center for Complementary and Integrative Health (NCCIH). Frequently Asked Questions: Name Change. [NCCIH Web site]. 12/17/2014. Available at: https://www.nccih.nih.gov/grants/faqs. Accessed April 16, 2024.

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 April 16, 2024.

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 April 16, 2024.

Rolf Institute of Structural Integration. [Rolf Institute of Structural Integration Web site]. 2018. Available at: http://www.rolf.org/. Accessed April 16, 2024.

Tabish SA. Complementary and Alternative Healthcare: Is it Evidence-based? Int J Health Sci (Qassim). 2008;2(1):V-IX. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068720/. Accessed April 16, 2024.

US Department of Health and Human Services. NIH National Center for Complementary and Integrative Health - NCCIH. Online resources. 01/2018. Available at: https://www.nccih.nih.gov/health/finding-and-evaluating-online-resources. Accessed April 16, 2024.

World Health Organization. Electromagnetic Fields. [WHO Web site]. 2015. Available at: http://www.who.int/peh-emf/en/. Accessed April 16, 2024.

Coding

CPT Procedure Code Number(s)

90880

ICD - 10 Procedure Code Number(s)

N/A

ICD - 10 Diagnosis Code Number(s)

N/A

HCPCS Level II Code Number(s)

H0051 Traditional healing service

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

MPMiscCodesNarrativesPub

Coding and Billing Requirements

Cross Reference

Policy History

Version Effective Date:

4/1/2024

Version Issued Date:

4/8/2024

Version Reissued Date:

5/15/2024