Your Complete Guide to Acupuncture

Acupuncture Cheat Sheet


What is acupuncture?

Acupuncture is a component of a system of medicine known as Traditional Chinese medicine (TCM) that has been in use for thousands of years. Acupuncture is the insertion of thin, disposable needles at specific locations through the skin to relieve pain and treat a variety of physical, mental, and emotional conditions. An acupuncturist is a licensed healthcare practitioner who holds either a Master’s or Doctorate in Traditional Chinese Medicine. Many people think of “acupuncture” as only the insertion of needles, however, the practice includes many other modalities, such as cupping, herbal medicine, massage (tui na), and more.

What can acupuncture help with?

Acupuncture is most commonly used for pain and treating chronic conditions such as insomnia, infertility, and chronic stress. However, acupuncture can also be helpful across a range of conditions - for acute issues (e.g. pain or sciatica) or chronic conditions - both optimization and prevention. Acupuncturists assess and address the whole person (for example, nutrition, symptoms of pain, sleep quality, etc.) and tend to treat patients holistically.

What happens during a session?

An initial visit for a private treatment can take between 90 to 120 minutes and involves an in-depth look at your health history in order to formulate a diagnosis and create a treatment plan. Your treatment will include acupuncture and other modalities such as cupping, massage (tui na), moxibustion, or acupressure massage based on your needs and preferences. Generally, the practitioner will perform the acupuncture and leave you in the room to relax for around 20-30 minutes.

Does acupuncture hurt? (Needles 101)

Acupuncture needles are thin, sterile, filiform needles made of superior quality stainless steel. Each needle is used one time and then disposed of safely. Needles generally cause no bleeding upon entry or removal, however, slight bruising can occasionally occur. Patients have also reported occasionally feeling a “tingle” when they’re inserted. Often patients do not feel them at all.

What’s the science behind acupuncture? How does it work?

Acupuncture activates several different biological systems: nervous, endocrine, musculoskeletal, circulatory, and lymphatic. When a needle is inserted, the immune system recognizes it as a foreign object and sends red and white blood cells to that area. This improves circulation to that body part and can activate healing.

At the same time, neurotransmitters like dopamine and serotonin (endorphins) are released in the brain, which are your “happy hormones” that improve mood and hormone regulation. This is why someone going in for neck pain will potentially overall feel less stressed and relaxed, potentially reducing anxiety and promoting better sleep!

What is Traditional Chinese Medicine? (TCM)

Traditional Chinese Medicine dates back over 2500 years, to ancient Taoist philosophy. TCM believes that the human body is made of over 2000 acupuncture points connected by meridians, or energetic pathways. Flowing through these pathways is energy flow, called Qi (pronounced “chee”). This energy flow is responsible for overall health, and when it’s disrupted we get sick. Inserting needles into certain points improves Qi flow, thus restoring balance and improving wellbeing. Modalities of TCM include cupping, herbal medicine or dietary supplements, massage, acupressure, moxibustion, breathing techniques, exercise and diet & nutrition counseling.

What type and how much education is required to become and acupuncturist in the US? ‍

Acupuncturists are recognized as licensed healthcare practitioners in the US. Becoming an licensed acupuncturist consists of a rigorous 4-year master’s program in Traditional Chinese Medicine, a clinical internship, and passing a board exam. Acupuncturists also have to renew their license every two years and complete 50 hours of board-approved continuing education courses.

How much does an acupuncture session cost? Will insurance cover it?

Depending on your practitioner and the specific treatment you are receiving, an acupuncture session can range from $20 (community acupuncture in a group setting) to a hundred dollars. The national average cost is around $75 for an hour-long session. Keep in mind you might have insurance coverage!‍

Many insurance plans in California now cover acupuncture. The exact amount and type depends entirely on your health needs, insurance company and plan. You can also pay using an FSA or HSA if you have one. You should call your insurance company or check their website for exact acupuncture coverage under your insurance plan.

How do I find a good acupuncturist?

Our goal here at Rupa Health is to make it seamless for you to find a trusted, credible acupuncturist that specifically fits your needs. We thoroughly vet all our acupuncturists using a process developed in conjunction with some of the top industry experts form institutions like Stanford, Johns Hopkins, etc.

We’ve found that it’s important to find someone with expertise in your specific condition, which is why we categorize & organize practitioners by specialty. We also note which insurance companies practitioners are in network with.

Acupuncture Deep Dive

Background: History & Science

THE ANCIENT VIEW

What is Traditional Chinese Medicine?

TCM dates back over 2500 years, to ancient Taoist philosophy. Traditional medicine systems also existed in other parts of Asia including Japan (where it’s called Kampo) and Korea. These systems overlap with TCM and were partially influenced by it, but have distinctive features.

TCM practitioners believe that the human body is made of over 2000 acupuncture points connected by meridiens, or energetic pathways. Flowing through these pathways is energy flow, called Qi (pronounced “chee”). This energy flow is responsible for overall health, and when it’s disrupted we get sick. Inserting needles into certain points is supposed to improve Qi flow therefore restoring balance and improving wellbeing.

These concepts are helpful for understanding the history of traditional chinese medicine, but today’s medical research on acupuncture doesn’t focus on these principles. It looks at the scientific principles behind specific parts of TCM, and evaluates them as treatment for specific symptoms and their effects on the body.

It’s important to separate ancient thought from evidence-based medical interventions. Ideally, we want to look at traditional theories through a modern, research-based lens and understand how they fit into science-based medicine.

When scientific bodies like the NCCIH do research studies on acupuncture, they do randomized controlled trials on acupuncture in the same way as they do on modern medical interventions.

What are other TCM modalities?

While acupuncture itself is the most rigorously studied and scientifically backed form of TCM, TCM encompasses many different practices. Link here.

The Modern View

What effect does acupuncture have on our bodies? Why does it work?

With today’s knowledge and research, many Western practitioners now view the acupuncture points as places to stimulate nerves, muscles and connective tissue. Some believe that this stimulation boosts your body's natural painkillers, by increasing neurotransmitters like serotonin and dopamine.

How does acupuncture work from an anatomical perspective?  

According to scientific research, inserting a needle in the body stimulates many body systems: nervous, endocrine, musculoskeletal, circulatory and lymphatic. The needle insertion elicits a response from the immune system, which recognizes it as  a foreign object and sends red and white blood cells to that area. This improves circulation to that body part.

There’s also a coinciding release of neurotransmitters like dopamine and serotonin (endorphins), which are known to regulate hormone function and improve mood. This is why even someone going in for neck pain will feel less stressed and relaxed, potentially leading to less anxiety and better sleep!


What is the science behind the acupuncture points and meridians?

There’s been a fair amount of scientific studies trying to pinpoint the science of  the meridiens, which were thought to be “energy channels” in traditional theory. It turns out that acupuncture points coincide with many points that are landmarks in our Western body systems.

  • Acupuncture points have a 80% correspondence with connective tissue planes both inter- and intramuscularly

  • Acupuncture points have a 71% correspondence with pain trigger points in the nervous system

  • The acupuncture points and their connecting meridiens may correspond to electric channels in our bodies

Experiencing Acupuncture: Needles & More

What can acupuncture help with? (Pain and beyond)

Acupuncture is the most widely validated to work wonders for headaches, back and neck pain, shoulder pain, leg pain, post-op pain, and almost any other type of pain. However, it also has been seen to alleviate digestive problems, menstrual irregularities, allergies, insomnia, stress and anxiety, asthma, and several other conditions. While many acupuncturists are generalists who treat a wide range of ailments, some specialize and there are extra certifications for certain specialties. (See specialties in the appendix.)

Regardless of background and health history, almost anyone is a good candidate for acupuncture. Even if you are healthy, acupuncture can help you maintain wellness, boost immunity and manage stress, all of which are preventative measures. Acupuncturists are trained to work in tandem with Western doctors to coordinate patient care. There’s often best results with an integrative approach.

Acupuncture can generally be beneficial for anyone, because of its preventative nature.  Laying on a table and having a practitioner work with you moves us from activating our sympathetic (fight or flight) to our parasympathetic (rest & digest) nervous system. This in itself provides relief and allows the body to function and heal as it normally should in a resting state.

Needles 101: Do they “hurt”? Are they reused? How big are they?

Acupuncture needles are regulated by the FDA just like other medical devices. They’re surveyed for good manufacturing practices and single-use sterility standards.

The CA Board of Acupuncture also prohibits acupuncturists from reusing needles, stating “it is unprofessional conduct for an acupuncturist to use a needle more than once”.

Needles come in a variety of sizes depending on where they are used and for what reason. Needles are sterile, generally cause no bleeding upon entry or removal, with little or no pain being felt; however, slight bruising may be experienced on occasion. They’re only the thickness of a few hairs and go a few millimeters deep into the skin.

Improper placement of the needle can cause pain during treatment. Needles must be sterilized to prevent infection.

What does acupuncture feel like?

The needle is inserted into a point in the skin that creates a sensation of mild pressure or ache, and in some cases is completely painless. Needles in some cases might be heated during treatment or mild electric current may be applied to them (called electroacupuncture).

Some people report acupuncture makes them feel energized, while others say they feel relaxed. Some people are so relaxed they fall asleep during treatments.

The Practitioner: Acupuncturist Education & Credentials

Who can perform acupuncture?

Acupuncture licensing is regulated at both the national and state level.

In California the following groups are legally allowed to perform acupuncture:

  • Acupuncturists who maintain a valid license issued by the Acupuncture Board

  • Physicians, dentists, and podiatrists licensed by their respective board, if they have completed the necessary training

  • Many physical therapists are now practicing “dry needling” which is similar to the needling component of acupuncture but focuses more acutely on muscle pain and movement impairments.

However, an actual acupuncturist  is more than just someone that can insert needles, they’re practitioners of traditional Chinese medicine, which involves a whole system of medicine.


What does it take to become an acupuncturist in California?

Becoming an acupuncturist in California requires at least a rigorous 4-years Masters program, plus a clinical internship, board examination, licensing and certification process, and ongoing continuing education and re-certification.

Additionally many choose to get a doctorate degree (PhD), which is 2.5 more years on top of the 4 year Masters in TCM. Some also do additional specializations or board seats, such as DNBAO or FABORM.

Step 1: Undergrad

  • Most acupuncture schools require having a Bachelor’s degree or at last 90-semester hours towards a Bachelor’s degree

  • It can usually be any type of Bachelor’s degree- no pre-requirements in terms of coursework unlike medical school

Step 2: Grad School + Clinical Internship

  • There are many types of Master’s degrees. They generally take 4 years, which leads to the title Licensed Acupuncturist or L.Ac.

  • Minimum of 3,000 hours of theoretical and clinical training  (Before 2005→ it was Minimum of 2,348 hours of theoretical and clinical training )

  • If you do a Doctorate on top of  that, its 2.5 more years and 2,500 more hours of clinical practice training

  • The school must be an approved school from this list.


What do all of the Acupuncture Titles and Terms mean?

There are many different titles and sylizations for acupuncturists, which can make understanding a practitioner’s qualifications confusing.

Every acupuncturist who has passed boards is a Licensed Acupuncturist, and can use the title “L.Ac.” after her name. Other formats include:

M.S. L.Ac.: Masters of Science Licensed Acupuncturist

MSTCM: Masters of Science in Traditional Chinese Medicine

The one major distinction is having a PhD in TCM versus a masters only. PhD graduates use many terms based on the school they attended.  

For example:

OMD: Oriental Medicine Doctor

DOAM: Doctor of Acupuncture and Oriental Medicine

DACM: Doctor of Acupuncture and Chinese Medicine

There are a few board specializations and certifications that acupuncturists can put after their name. The two most common & respected are:

FABORM: Fellow, American Board of Oriental Reproductive Medicine

DNBAO: Diplomate, National Board of Acupuncture Orthopedics

See our other article for a complete list of acupuncture titles and terms.

Acupuncturist Specialties

While there aren’t official board certifications within Traditional Chinese Medicine, most practitioners tend to like treating certain conditions more than others, and have high level of knowledge and experience with specific areas. When choosing an acupuncturist, it’s smart to find someone who treats many patients with your condition. The practitioners within our Rupa Health network all have listed specialties & patient focuses.

How do I find a trusted acupuncturist?

Check out our network of highly vetted providers at Rupa Health.

Logistics: Going + Paying

GOING

What can I expect from an initial session?

Most acupuncturists’ first session is longer than a follow-up session, usually lasting 90 minutes or more. Often, you’ll be asked to fill out comprehensive intake forms before the initial appointments, with your personal health history and family history.

During a first session, he/she may also do the following in person:

  • Get a comprehensive medical history and family history of illness

  • Get details about your chief complaint for coming to acupuncture (if there is one)

  • Ask questions about your lifestyle, such as:

    • Diet

    • Exercise

    • Type of work you do

    • Menstrual cycle

    • Past medical history

    • Bowel movements

  • Perform any mix  of acupuncture, acupressure massage, cupping, moxibustion, or more. You can always ask for explanations of what is happening, or refuse certain treatments if you feel uncomfortable.

  • Recommend lifestyle changes or prescribe herbs


What can I expect from a follow-up session?

Most follow-up treatments are about 60 minutes. Often you won’t get the same treatment every time you go in. Generally, acupuncturists will ask before a session what you’ve been experiencing that week and what areas you want to work on. They may target specific areas related to recent pain.

If it’s for a chronic condition, the consecutive treatments may be more similar to one another.


How often do I need to go?

After your first treatment, your acupuncturist will usually provide a personalized plan including an estimate for how many treatments you’ll likely need. This is always an estimate because response times to acupuncture varies widely, but it’s a good guideline. Generally, when starting out, many acupuncturists will have you come in 1-2x per week. Some acupuncturists say that for a chronic condition, you should see your acupuncturist for 1 month corresponding to each year that you’ve suffered from it. For acute conditions, the number of sessions needed varies depending on your response to the treatment.

Acupuncture works cumulatively, which means each treatment builds onto the next. Similar to how medications aren’t effective unless you take the prescribed dose, if you don’t get acupuncture consistently and within an appropriate time frame it is unlikely to yield the desired result.

Do I need a referral?

In some cases yes, in others no. This largely depends on your insurance coverage.

Many insurance companies do cover acupuncture treatment; however a referral may or may not be required for insurance purposes. For more information on insurance and referrals, please contact your insurance company.

If you’re paying out of pocket and going to a private acupuncture practice, you don’t need a referral.

What is community acupuncture?

Group-based, community acupuncture is a model gaining in popularity in the US because its a lower-cost alternative to acupuncture, and works on a sliding-fee scale. This means you pay what you can afford, generally ranging from $20 - $60 a session.

In community acupuncture, you’ll be in a room with several people in comfortable, reclining style chairs. You’ll be able to keep your clothes on and most needles will be inserted in the distal parts of your body (arms and legs). It’s quiet and calming, and the acupuncturist will circulate the room and treat everyone.

You’ll be able to communicate to the acupuncturist privately what you want worked on before  that day’s session.

Companies such as Modern Acupuncture are looking to bring community acupuncture to the masses.


PAYING

What does it cost?

Depending on your practitioner, an acupuncture session can range from $20 (community acupuncture) to several hundreds, depending on the specific treatment you’re getting. The national average cost is around $75 for an hour-long session. Keep in mind you might have insurance coverage!

All insurance plans in California have some kind of acupuncture coverage. This  can range from 100% coverage to partial, which depends entirely on your health needs and insurance company and plan. You can also pay using an HSA or FSA account if you have one.

How does insurance work with acupuncture?

Since 2014 in California, acupuncture is an essential health benefit, which means every plan has some kind of coverage.

You should call your insurance company or check their website for exact acupuncture coverage.

Can I use HSA / FSA?

HSA/FSA can both be used for acupuncture treatment!  FSA is “use it or lose it”, so you lose remaining funds at the end of the year.

How do I find out my coverage for each type of affiliation? Different coverages by network- research

Call or visit your insurance provider’s site.

How do I find out what my insurance company will reimburse for an out-of-network provider?

Call the customer service phone number listed on your insurance card. One way you can do this:

  • Ask, “I want to work with an out-of-network acupuncturist, how much will you reimburse me?”

    • Some customer service reps may not know about acupuncturists or what they do.  If they ask what an acupuncturist is, you can tell them, “Acupuncturists are licensed medical providers in the state of California.”

  • Ask, “What is the best way to submit my claim for reimbursement with a superbill?”

  • Be sure that your insurance plan benefits are clear to you - what should your health plan cover? What health services count toward your deductible?

How do I submit an acupuncture superbill to my insurance?

  • A superbill is a form that your acupuncturist might give you, that’ll allow you to apply for reimbursement directly from your insurance company

  • The parts of the Superbill describing services rendered are completed by the medical practitioner

  • A superbill doesn’t guarantee that an insurance provider will pay for the services provided. Each insurance plan is different, and it is your responsibility to contact your insurance provider and find out exactly will be covered.