Section 410.438 - Acupuncture(A)Introduction. MassHealth members are eligible to receive acupuncture for the treatment of pain as described in 130 CMR 410.438(C), for use as an anesthetic as described in 130 CMR 433.454(C): Acupuncture as an Anesthetic, and for use for detoxification as described in 130 CMR 418.406(C)(3): Acupuncture Detoxification.(B)General. 130 CMR 410.438 applies specifically to acupuncture services rendered in a hospital by physicians and licensed practitioners of acupuncture.(C)Acupuncture for the Treatment of Pain. MassHealth provides a total of 20 sessions of acupuncture for the treatment of pain per member per year without prior authorization. If the member's condition, treatment, or diagnosis changes, the member may receive more sessions of medically-necessary acupuncture treatment with prior authorization.(D)Provider Qualifications for Acupuncture. (1)Qualified Providers. MassHealth pays a hospital for acupuncture services only when the provider rendering the service is: (b) licensed in acupuncture by the Massachusetts Board of Registration in Medicine under 243 CMR 5.00: The Practice of Acupuncture.(2)Acupuncture Providers in Hospitals. Hospitals must ensure that acupuncture providers for whom the hospital will submit claims possess the appropriate training, credentials, and licensure(E)Conditions of Payment. The MassHealth agency pays the hospital for services of an acupuncturist qualified to render such services in accordance with 130 CMR 410.438(D) only when: (1) the services are limited to the scope of practice authorized by state law or regulation (such as 243 CMR 5.00: The Practice of Acupuncture); and(2) the provider has a current license or certificate of registration from the Massachusetts Board of Registration in Medicine.(F)Acupuncture Claims Submissions. (1) Hospitals may submit claims for on-site acupuncture services when a provider qualified to render such services in accordance with 130 CMR 410.438(D) provides those services directly to MassHealth members. See Subchapter 6 of the Acute Outpatient Manual for service code descriptions and billing requirements.(2) For MassHealth members receiving services under any of the acupuncture codes on the same date of service as a visit, the hospital may bill for both the visit and the acupuncture services.Amended by Mass Register Issue 1344, eff. 7/28/2017.Amended by Mass Register Issue 1461, eff. 1/21/2022.