Subject:
Cupping Therapy
Description:
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IMPORTANT NOTE:
The purpose of this policy is to provide general information applicable to the administration of health benefits that Horizon Blue Cross Blue Shield of New Jersey and Horizon Healthcare of New Jersey, Inc. (collectively “Horizon BCBSNJ”) insures or administers. If the member’s contract benefits differ from the medical policy, the contract prevails. Although a service, supply or procedure may be medically necessary, it may be subject to limitations and/or exclusions under a member’s benefit plan. If a service, supply or procedure is not covered and the member proceeds to obtain the service, supply or procedure, the member may be responsible for the cost. Decisions regarding treatment and treatment plans are the responsibility of the physician. This policy is not intended to direct the course of clinical care a physician provides to a member, and it does not replace a physician’s independent professional clinical judgment or duty to exercise special knowledge and skill in the treatment of Horizon BCBSNJ members. Horizon BCBSNJ is not responsible for, does not provide, and does not hold itself out as a provider of medical care. The physician remains responsible for the quality and type of health care services provided to a Horizon BCBSNJ member.
Horizon BCBSNJ medical policies do not constitute medical advice, authorization, certification, approval, explanation of benefits, offer of coverage, contract or guarantee of payment.
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Cupping is a traditional Chinese medicine therapy dating back at least 2,000 years. It has been promoted for use in the treatment of a variety of diseases/conditions including, but not limited to, hypertension, headache, herpes zoster, cough, asthma, common cold, acne, facial paralysis, and other pain conditions (e.g., back pain, frozen shoulder).
Cupping therapy involves warming the air inside a cup (made of materials such as glass, bamboo, horn or earthenware) using flammable substances such as alcohol, herbs, or paper. The cup is then placed upside down over the patient's skin to create a vacuum causing the skin to rise. Modern cupping practitioners use magnetic or hand pumps to create suction. The mechanism of cupping therapy is not clear, but some researchers suggest that placement of cups on selected acupoints on the skin produces hyperemia or hemostasis, which results in a therapeutic effect. (1)
There are many types of cupping therapy and the most common types include empty cupping, retained cupping, flash cupping, moving cupping, wet cupping, medicinal (herbal) cupping, and needling cupping.
Cupping may cause bruising and burn marks similar to abuse in a child or in an adult, and mandatory reporters need to be able to identify the difference.
From UpToDate: Many cultures use various means to mark the skin in order to treat various illnesses and conditions. They include cupping, coining, spooning, moxibustion, caida de mollera, and salting …[T]he practices described below have not been reported to cause harm to the child and in fact, demonstrate efforts to improve the child’s health. They should not be considered as a form of abuse. Because cultural practices may be administered instead of bringing children to effective medical care, they may at times be a part of medical neglect.
Cupping — In cupping, the air in an open-mouthed vessel is heated by various means, and then, the vessel is applied to the skin. The suction force created by the cooling and contracting of the heated air is thought to "draw out" the ailment. The heated air and the rim of the cup burn the skin. This technique is used in Middle Eastern, Asian, Latin American, and Eastern European cultures. Cupping presents as multiple, grouped circular ecchymoses, usually on the back. Central ecchymosis or petechiae result from the suction effect of the heated air as it cools and contracts
Policy:
(NOTE: For Medicare Advantage, Medicaid and FIDE-SNP, please refer to the Coverage Sections below for coverage guidance.)
Cupping therapy is considered investigational for all indications.
Medicare Coverage:
There is no National Coverage Determination (NCD) or Local Coverage Determination (LCD) for jurisdiction JL for this service. Therefore, Medicare Advantage Products will follow the Horizon BCBSNJ Medical Policy.
Medicaid Coverage:
For members enrolled in Medicaid and NJ FamilyCare plans, Horizon BCBSNJ applies the above medical policy.
FIDE-SNP:
For members enrolled in a Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP): (1) to the extent the service is covered under the Medicare portion of the member’s benefit package, the above Medicare Coverage statement applies; and (2) to the extent the service is not covered under the Medicare portion of the member’s benefit package, the above Medicaid Coverage statement applies.
[RATIONALE: According to recent systematic reviews done to evaluate the therapeutic effects of cupping therapy for various diseases/conditions, the number of randomized controlled trials are scarce in terms of a specific disease. In addition, most of the trials are of small size and of low methodological quality (e.g., high risk of bias). Further larger and rigorously designed controlled trials are needed to assess the effectiveness of cupping therapy and allow for a definitive conclusion. Thus, cupping therapy is considered investigational.]
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Horizon BCBSNJ Medical Policy Development Process:
This Horizon BCBSNJ Medical Policy (the “Medical Policy”) has been developed by Horizon BCBSNJ’s Medical Policy Committee (the “Committee”) consistent with generally accepted standards of medical practice, and reflects Horizon BCBSNJ’s view of the subject health care services, supplies or procedures, and in what circumstances they are deemed to be medically necessary or experimental/ investigational in nature. This Medical Policy also considers whether and to what degree the subject health care services, supplies or procedures are clinically appropriate, in terms of type, frequency, extent, site and duration and if they are considered effective for the illnesses, injuries or diseases discussed. Where relevant, this Medical Policy considers whether the subject health care services, supplies or procedures are being requested primarily for the convenience of the covered person or the health care provider. It may also consider whether the services, supplies or procedures are more costly than an alternative service or sequence of services, supplies or procedures that are at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of the relevant illness, injury or disease. In reaching its conclusion regarding what it considers to be the generally accepted standards of medical practice, the Committee reviews and considers the following: all credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, physician and health care provider specialty society recommendations, the views of physicians and health care providers practicing in relevant clinical areas (including, but not limited to, the prevailing opinion within the appropriate specialty) and any other relevant factor as determined by applicable State and Federal laws and regulations.
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Index:
Cupping Therapy
Cupping
References:
1. Cao H, Li X, Liu J. An updated review of the efficacy of cupping. PLoS One. 2012;7(2):E31793. Epub 2012 Feb 28.
2. Kim JI, Lee MS et al. Cupping for treating pain: a systematic review. Evid Based Complement Altern Med. Volume 2011, Article ID 467014, doi:10.1093/ecam/nep035
3. Lee MS, Kim JI, Ernst E. Is cupping an effective treatment? An overview of systematic reviews. J Acupunct Meridian Stud. 2011 Mar;4(1):1-4.
4. Cao H, Han M et al. Clinical research evidence of cupping therapy in China: a systematic literature review. BMC Complent Altern Med. 2010 Nov 16;10:70.
5. Cao H, Zhu C, Liu J. Wet cupping therapy for treatment of herpes zoster: a systematic review of randomized controlled trials. Altern Ther Health Med. 2010 Nov-Dec;16(6):48-54.
6. Lee MS, Choi TY et al. Cupping for hypertension: a systematic review. Clin Exp Hypertens. 2010;32(7):423-5. Epub 2010 Sep 9.
7. Lee MS, Choi TY et al. Cupping for stroke rehabilitation: a systemactic review. J Neurol Sci. 2010 Jul 15;294(1-2):70-3.
8. American Cancer Society. Cupping. Available at:http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/manualhealingandphysicaltouch/cupping (last accessed 10/29/2014)
9. Khan AA, Jahangir U, Urooj S. Management of knee osteoarthritis with cupping therapy. J Adv Pahrm Technol Res 2013 Oct;4(4):217-23.
10. Hon KL, Luk DC, Leong KF, et al. Cupping Therapy May Be Harmful for Eczema: A PubMed Search. Case Rep Pediatr Epub 2013 Oct 27.
11. Lauche R, Cramer H, Langhorst J, et al. Cupping for chronic nonspecific neck pain: a 2-year follow-up. Forsch Komplemenmed Epub 2013 Oct 18.
12. Lauche R, Langhorst J, Dobos GJ, et al. Clinically meaningful differences in pain, disability and quality of life for chronic nonspecific neck pain - a reanalysis of 4 randomized controlled trials of cupping therapy. Complement Ther Med 2013 Aug;21(4):342-7.
13. Huang CY, Choong MY, Li TS .Effectiveness of cupping therapy for low back pain: a systematic review. Acupunct Med. 2013 Sep;31(3):336-7. doi: 10.1136/acupmed-2013-010385. Epub 2013 Jul 25.
14. Cao HJ(1), Liu JP, Hu H, Wang NS. Using a partially randomized patient preference study design to evaluate the therapeutic effect of acupuncture and cupping therapy for fibromyalgia: study protocol for a partially randomized controlled trial. Trials. 2014 Jul 10;15:280. doi: 10.1186/1745-6215-15-280.
15. Bao Y(1), Kong X(2), Yang L(3) et al. Complementary and alternative medicine for cancer pain: an overview of systematic reviews. Evid Based Complement Alternat Med. 2014;2014:170396. doi: 10.1155/2014/170396.
Epub 2014 Apr 13.
16. Cho HW(1), Hwang EH(2), Lim B(3) et al. How current Clinical Practice Guidelines for low back pain reflect Traditional Medicine in East Asian Countries: a systematic review of Clinical Practice Guidelines and systematic reviews. PLoS One. 2014 Feb 5;9(2):e88027.
17. Aleyeidi NA, Aseri KS, Matbouli SM, et al. Effects of wet-cupping on blood pressure in hypertensive patients: a randomized controlled trial. J Integr Med 2015 Nov;13(6):391-9.
18. Mehta P, Dhapte V. Cupping therapy: A prudent remedy for a plethora of medical ailments. J Tradit Complement Med 2015 Feb 10;5(3):127-34.
19. AlBedah A, Khalil M, Rlolemy A, et al. The use of wet cupping for persistent nonspecific low back pain: randomized controlled clinical trial. J Altern Complement Med 2015 Aug;21(8):504-8.
20. Cao H, Li X, Liu J. An Updated Review of the Efficacy of Cupping Therapy. PLos One 2012;7(2):e31793.
21. Kavadar G, Demircioglu DT, Can H, et al. The clinical factors associated with benefit finding of complementary medicine use in patients bwith back pain: A cross-sectional study with cluster analysis. J Back Musculoskelet Rehabil 2016 Sep 23. [Epub ahead of print]
22. Al Bedah AM, Khalil MK, Posadzki P, et al. Evaluation of Wet Cupping Therapy: Systematic Review of Randomized Clinical Trials. J Altern Complement Med 2016 Oct;22(10):768-777.
23. Chi LM, Lin LM, Chen CL, et al. The Effectiveness of Cupping Therapy on Relieving Chronic Neck and Shoulder Pain: A Randomized Controlled Trial. Evid Based Complement Alternat Med 2016;2016:7358918.
24. Teut M, Ullmann A, Ortiz M, et al. Pulsatile dry cupping in chronic low back pain – a randomized three-armed controlled clinical trial. BMC Complementary and Alternative Medicine. 2018;18:115. doi:10.1186/s12906-018-2187-8.
25. Bridgett R, Klose P, Duffeild R, et al. Effects of Cupping Therapy in Amateur and Professional Athletes: Systemic Review of Randomized Controlled Trials.
26. Boos SC. Differential diagnosis of suspected child physical abuse. In: UpToDate, Lindberg DM, Drutz JE, Wiley II JF (Eds), UpToDate, Waltham, MA. (Accessed on July 14, 2020.)
Codes:
(The list of codes is not intended to be all-inclusive and is included below for informational purposes only. Inclusion or exclusion of a procedure, diagnosis, drug or device code(s) does not constitute or imply authorization, certification, approval, offer of coverage or guarantee of payment.)
CPT*
HCPCS
* CPT only copyright 2020 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
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Medical policies can be highly technical and are designed for use by the Horizon BCBSNJ professional staff in making coverage determinations. Members referring to this policy should discuss it with their treating physician, and should refer to their specific benefit plan for the terms, conditions, limitations and exclusions of their coverage.
The Horizon BCBSNJ Medical Policy Manual is proprietary. It is to be used only as authorized by Horizon BCBSNJ and its affiliates. The contents of this Medical Policy are not to be copied, reproduced or circulated to other parties without the express written consent of Horizon BCBSNJ. The contents of this Medical Policy may be updated or changed without notice, unless otherwise required by law and/or regulation. However, benefit determinations are made in the context of medical policies existing at the time of the decision and are not subject to later revision as the result of a change in medical policy
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