GENERAL ACUPUNCTURE PROTOCOL
The Massachusetts General Acupuncture Protocol must be consulted when Massachusetts Treatment Guidelines do not address acupuncture treatment for a specific diagnosis. The Health Care Services Board recognizes that for certain medical conditions, as an adjunct to physical rehabilitation and/or surgical intervention for pain relief when there is a delayed recovery or when pain medication is reduced or not tolerated, acupuncture treatments may provide beneficial relief and rehabilitation of the injured employee. Acupuncture treatments may also be beneficial for injured employees who have not responded to treatment options specified in the appropriate treatment guideline. It is expected that approximately 10% of cases may fall outside of this guideline and may be reviewed and approved on a case by case basis.
1) Acupuncture may be authorized when ordered by a licensed MD, DC, DO, PA, NP, or PT. The ordering practitioner cannot also be the provider of the service.
2) There is clear documentation that the patient has not responded to appropriate and reasonable medical, surgical, and chiropractic services as set forth in the applicable treatment guideline.
3) Acupuncture must be performed by an acupuncturist licensed by the Board of Registration in the state where the service will be provided.
Trial of acupuncture will not exceed six (6) visits in the first eight (8) weeks unless indicated in the applicable Massachusetts Treatment Guideline.