Does New York State's workers' compensation cover acupuncture treatments?
- caulocare
- Mar 19
- 3 min read
New York State Workers' Compensation covers acupuncture treatments, but there are specific requirements and limitations involved.
Acupuncture Coverage Under New York Workers' Compensation
In New York, acupuncture became a recognized treatment under the Workers' Compensation system as of January 1, 2020. This means that licensed acupuncturists can provide treatment for work-related injuries or illnesses if they meet certain conditions.
Key Points About Coverage:
Acupuncturists Must Be Authorized:
Not all acupuncturists can treat workers' compensation cases.
The acupuncturist must be authorized by the New York State Workers' Compensation Board (NYSWCB) to provide services for injured workers.
A Medical Provider Must Recommend Acupuncture:
A treating physician, nurse practitioner, or other medical provider must refer the patient for acupuncture treatment.
This ensures that acupuncture is medically necessary and part of the worker's rehabilitation plan.
Treatment Is Subject to the New York Workers' Compensation Fee Schedule:
Acupuncture treatments must follow the reimbursement rates set by the NYSWCB.
These rates may limit the number of treatments covered or the amount paid per session.
Workers' Compensation Insurers May Review Treatment Plans:
Insurance companies handling workers' compensation claims may request a review of the necessity of continued acupuncture treatments.
This means ongoing treatment could require additional documentation from the treating physician or acupuncturist.
The Coverage Is Specifically for Work-Related Injuries:
The injury must be directly related to a workplace accident or occupational condition.
Acupuncture for general wellness or non-work-related conditions is not covered under workers' compensation.
What Injuries and Conditions Can Acupuncture Treat Under Workers' Compensation?
Acupuncture is commonly used for pain management and rehabilitation in workers' compensation cases. Some common conditions it helps with include:
Back pain and spinal injuries
Neck and shoulder pain (including whiplash from work accidents)
Repetitive strain injuries (RSI), such as carpal tunnel syndrome
Sciatica and nerve pain
Chronic pain syndromes related to work injuries
Tendonitis and muscle strain
Post-surgical recovery
Work-related stress, anxiety, and sleep disturbances
How to Get Acupuncture Covered Under Workers' Compensation in New York
If you were injured at work and want acupuncture covered, you need to follow these steps:
File a Workers' Compensation Claim
Report your injury to your employer and ensure a workers' compensation claim is filed.
Get a Referral from Your Treating Physician
Your doctor or another authorized medical provider must recommend acupuncture as part of your treatment plan.
Find an Authorized Acupuncturist
The acupuncturist must be registered with the New York State Workers' Compensation Board.
Ensure Proper Billing and Documentation
Your acupuncturist should follow state billing codes and regulations to avoid claim denials.
Monitor Your Treatment Plan
The workers’ compensation insurer may review your progress periodically to determine if acupuncture should continue.
Can an Insurance Company Deny Acupuncture Treatment?
Yes, a workers' compensation insurer can deny acupuncture coverage under certain circumstances, such as:
Lack of medical necessity (i.e., no doctor’s referral)
If the treatment is not work-related
If the acupuncturist is not authorized to provide care under NY workers’ compensation
If the number of sessions exceeds what is considered reasonable under NYS guidelines
If your acupuncture treatment is denied, you can appeal the decision through the New York State Workers' Compensation Board.
Summary
✅ Acupuncture is covered under New York Workers' Compensation if:
It is prescribed by a medical provider.
It is performed by an authorized acupuncturist.
It follows NYS Workers’ Compensation Board guidelines.
⛔ Coverage may be denied if:
The injury is not work-related.
The treatment is not deemed necessary by the insurer.
The provider is not authorized under NY Workers' Comp rules.
New York State's workers' compensation system covers acupuncture treatments. Effective January 1, 2020, licensed acupuncturists, along with other healthcare providers, can be authorized by the New York State Workers' Compensation Board to treat patients with work-related injuries or illnesses. However, a referral from the treating medical provider is required for acupuncture services.
Reimbursement for these services is determined according to the New York State Workers' Compensation Acupuncture and Physical & Occupational Therapy Fee Schedule.
It's important to note that while acupuncture is covered under workers' compensation, its coverage under other health insurance plans in New York may vary. As of January 31, 2025, efforts are underway to designate acupuncture as an "essential health benefit" to ensure broader access and coverage for all residents.
This information is only educational and should not be construed as medical advice.
Everything must be balanced, and the suggestions may not apply to you.
A specialist doctor should be consulted for any medical advice or diagnosis.
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Dr. Phumlarp Caulo LA,c, MAc. OM, DAHM
Doctor of Acupuncture/Chinese Medicine
Caulo Care Acupuncture
#acupuncturetherapy #worders'compensation
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