Dry needling is a therapeutic technique where a trained practitioner inserts thin, sterile needles into the skin and muscle to target myofascial trigger points. This process is called “dry” because the needle does not inject any medication or fluid. The objective is to elicit a local twitch response, which helps release muscle tension, improve blood flow, and reduce pain, often leading to improved range of motion. Determining insurance coverage is complex, as it varies widely based on the specific plan, the provider’s license, and how the service is documented and billed.
The Classification Challenge
The primary challenge in securing insurance coverage for dry needling stems from a lack of standardized classification by payers. Dry needling is a modern, Western-medicine approach targeting specific muscle trigger points based on anatomical and neurophysiological principles. This approach is distinct from acupuncture, which is rooted in Traditional Chinese Medicine and involves needling along meridians. Insurance companies often ignore this distinction, frequently lumping dry needling with acupuncture or labeling it as unproven. Providers bill using two specific Current Procedural Terminology (CPT) codes: 20560 (one or two muscles) and 20561 (three or more muscles). Coverage ultimately depends on the insurer’s determination of “medical necessity,” meaning the treatment must be reasonable, necessary, and appropriate for the patient’s condition.
Major Private Insurer Policies
The policies of the largest commercial insurance carriers generally reflect a cautious and restrictive approach to covering dry needling. Coverage status is rarely straightforward, requiring patients to confirm their specific plan details rather than relying on general company policy.
Aetna typically classifies dry needling as “experimental, investigational, or unproven” in its medical policy bulletins, resulting in denial of coverage under most standard plans. Cigna also frequently excludes dry needling, often listing it as a non-covered service in its physical therapy guidelines. This exclusion is usually based on the insurer’s assessment that there is insufficient scientific evidence to support its routine use.
UnitedHealthcare (UHC) commercial plans often follow a similar pattern, frequently denying claims unless the treatment falls under a specific, limited plan rider. Coverage may also be granted if the service is performed as part of an overall covered physical therapy plan that meets strict medical necessity criteria.
Blue Cross Blue Shield (BCBS) coverage is the most variable, as the company operates through independent local plans. Some local BCBS plans deem dry needling “investigational” for all applications, automatically leading to non-coverage. Other BCBS plans may cover the service when performed by a licensed physical therapist and billed under the appropriate CPT code, provided the patient’s diagnosis meets the plan’s definition of medical necessity.
Government Coverage Rules
Federal and state government programs apply a specific set of rules for dry needling coverage that differ significantly from private insurers. Medicare, the federal health insurance program for seniors, provides coverage only when dry needling is used to treat chronic low back pain (cLBP). For coverage purposes, cLBP is defined as non-specific pain lasting 12 weeks or longer.
Under Medicare Part B, a patient may receive up to 12 treatments within 90 days, with an additional eight sessions possible if improvement is documented, for a maximum of 20 treatments per year. Medicare requires the service to be performed by a provider who possesses a master’s or doctoral-level degree in acupuncture or Oriental Medicine from an accredited school. This credentialing requirement means many physical therapists who practice dry needling may not be eligible to bill Medicare for the service.
Medicaid, the joint federal and state program for low-income individuals, has coverage policies that vary dramatically because each state administers its own program. Some state Medicaid programs may cover dry needling if it is performed as an integral part of a covered physical therapy treatment and is considered medically necessary. Other state Medicaid programs strictly exclude the service, requiring patients to consult their state’s specific plan documents.
Confirming Coverage and Appeals
Due to the inconsistent nature of dry needling coverage, the most reliable way to determine financial responsibility is through proactive verification before treatment begins. Patients should first ask the treating practitioner for the specific CPT code (20560 or 20561) and the primary diagnostic code (ICD-10) they plan to use. With this information, the patient can contact their insurance provider directly to request a pre-authorization or detailed benefit verification.
When speaking with the insurer, patients should confirm several key details:
- If the specific CPT codes are covered for the diagnosis.
- Whether the provider is in-network for those codes.
- If the coverage is subject to a deductible.
- If the coverage is subject to a co-payment.
If the claim is denied, the patient has the right to file an internal appeal, typically involving a formal letter of appeal. This letter should be supported by a Letter of Medical Necessity (LMN) written by the treating provider. The LMN must detail the patient’s history, prior failed treatments, and the specific rationale for why dry needling is medically necessary.
If the internal appeal is unsuccessful, patients can pursue an external review, where an independent third party reviews the insurer’s decision. Overturning a denial depends on providing robust documentation that links the procedure to functional improvement and demonstrates medical necessity. Patients should be prepared to discuss cash-pay options if they choose to proceed while the claim is under review or if the service is clearly non-covered.