Evidence-based treatment guidelines Course of Treatment Based on Peer Reviewed Clinical Coverage Guidelines Devised by Centers for Medicare and Medicaid Services (CMS), National Coverage Determination for Acupuncture and Foundation for Acupuncture Research. Acupuncture and electroacupuncture. Normally an initial course of treatment consists of 12 to 18 treatments over a 4 to 6-week period, depending on complicating factors. For acute conditions, fewer treatments may be necessary to observe a therapeutic effect and to obtain complete recovery. For chronic conditions, such as in this case, and in conditions with complicating factors, extended treatment is recommended to observe response to treatment. As in most types of therapy, the earlier the patient receives treatment, the greater the probability of recovery, and the shorter the time to recovery. Acupuncture is commonly utilized in chronic conditions because of effectiveness in pain management and limited treatment options. However, it should be noted that acupuncture and electro-acupuncture can lead to complete recovery in many NMS conditions when it is offered in the acute and sub-acute stages of injury, particularly when used in conjunction with other therapeutic interventions, such as range of motion (ROM) and strengthening exercises and manual manipulation of the soft tissue. Acupuncture or electroacupuncture are rarely performed as a single treatment, but are usually prescribed and performed as a series, or "course of treatments." Thus, treatment planning requires a recommendation for the number, frequency, and duration of treatments that is appropriately based upon the nature and extent of the injuries and the prognosis for a progressive and timely recovery from those injuries. Severe injuries, multiple injuries, metabolic disorders, and other complicating factors may require more frequent treatments over a longer duration of time. For example, while some multiple injuries can be treated simultaneously, others must be treated independently and sequentially, requiring increased treatment frequency. Recommended Additional Course of Treatment A conservative recommendation of a series of 12 additional visits are recommended. Treatment based on medical necessity shall be determined at time of service based on subjective complaints and observations. Re-Evaluation: A detailed or focused re-evaluation designed to determine the patient's progress and response to treatment should be conducted at the end of each course of treatment. Additionally, a brief assessment of the patient’s response to each treatment should be noted after each treatment is completed, and again before the next one is started, and recorded in progress notes (e.g., SOAP notes). When a patient's condition is not responding to treatment for a period of 2 to 3 weeks, a more thorough re-evaluation should be conducted immediately to determine if the condition is different or more serious than the initial diagnosis had indicated and/or whether the condition requires further diagnostic testing and/or referral to other diagnostic or treatment specialists. Follow-up courses of treatment may be similar in frequency and duration to the initial course of treatment. However, one of the goals of any treatment plan should be to reduce the frequency of treatments to the point where maximum therapeutic benefit continues to be achieved while encouraging more active self-therapy, such as strengthening and range-of-motion (ROM) exercises, and rehabilitative exercises. The frequency of continued treatment generally depends upon the severity and duration of the condition; treatment benefits are generally stronger and last longer as a condition moves from acute towards complete resolution and as the patient takes a more active role in his or her recovery. •Acute - 2-3 treatments per week for 4 weeks, decreasing frequency as symptoms resolve and are reduced. Reevaluate after 12th visit.•Sub-Acute - 2-3 treatments per week for up to four weeks. 1-2 treatments per week thereafter for up to 6-8 weeks. This is also thetime when a rehabilitation exercise program is usually introduced. Reevaluate after 12th visit.•Chronic – 12 visits, 1-2 treatments per week for 6-8 weeks. Reevaluate after 12th visit.•Recurrent/Flare-Up - 1-2 treatments per week for 6-8 weeks. Reevaluate after 12th visit.Acupuncture is considered medically necessary for the following indications: •As a treatment for acute or chronic pain, including postoperative, musculoskeletal, neurogenic, vascular, craniomandibular, andmalignant pain; OR,•For postoperative nausea and vomiting (including children); OR,•For morning sickness associated with pregnancy; OR,•For chemotherapy-associated nausea and vomitingThe Acupuncture Clinical Guidelines/Plan of Care Recommendations - Peer Reviewed: 1. Hayes Directory. Acupuncture for Pain. January 20, 2005.2. Hayes Directory. Acupuncture and Acupressure for the Treatment of Nausea and Vomiting. June 20, 2005.3. Hayes Directory. Acupuncture for Treatment of Addictive Behavior. May 31, 2005. Government Agencies, Professional and Medical Organizations: 1. Centers for Medicare and Medicaid Services (CMS), National Coverage Determination for Acupuncture (30.3)2. Centers for Medicare and Medicaid Services (CMS), National Coverage Determination for Acupuncture for Fibromyalgia (30.3.1)3. Centers for Medicare and Medicaid Services (CMS), National Coverage Determination for Acupuncture for Osteoarthritis (30.3.2)4. Council of Acupuncture and Oriental Medicine Associates (CAOMA), Foundation for Acupuncture Research. Acupuncture and electroacupuncture. Evidence-based treatment guidelines. Calistoga (CA): Council of Acupuncture and Oriental Medicine Associates (CAOMA); 2004 Dec.