A Modern Guide to State Acupuncture Laws

What I learned building the ultimate licensing spreadsheet for community acupuncturists.

 

Guest post by The Honorable Elizabeth Ropp, L.Ac. in New Hampshire

I put together a spreadsheet of acupuncture licensing laws with the help of Oregon-based acupuncturist Maddie Foley. This is a quick “at a glance” reference, but all of the links to the laws and regulatory websites are available for diving deeper.

You can view that spreadsheet here: Acupuncture Licensing Requirements by State

Thank you to the many of you who contributed to this project: Nityamo Lian, Keith Zabik, Greg Jones, Craig Labadie, Cris Monteiro, Micaela (Mickey) Foley, Ellen Vincent, Alexa Hulsey, Travis Beto, Chris Rogers and Elaine Wolf Komarow. Thank you to Lisa Rohleder for suggesting this project.  I also want to thank Cornell Law School for providing additional acupuncture licensing information on its website. What an unexpected discovery!

One thing is certain: laws are always changing, and that includes acupuncture laws. The practice act in the state where I live has gone through several changes over the last few years. We need updated information readily available to be better informed as a profession. At this time, the future of the acupuncture profession is uncertain. Having more information may be helpful in knowing which states offer reciprocity and which states could stand to be more flexible.

The latest resource for acupuncture practice acts that I know of was compiled in 2014 by lobbyist Mark Guimond (Acupuncture State Law Summary). I’ve used his handy summary many times over the years. However, at the time it was written, North Dakota and Wyoming did not have practice acts—which they do now.

I inherited a copy of Barbara B. Mitchell’s 2001 edition of Acupuncture and Oriental Medicine Laws from my friend and mentor, acupuncturist and NADA trainer, Laura Cooley. I am curious to know how many editions Barbara Mitchell published. If anyone knows the answer, please leave a comment.

I learned quite a bit while putting the spreadsheet together, and I want to share some of that with all of you. Feel free to share this with your colleagues.

Educational (non-acupuncture) Prerequisites 

The states that explicitly require post-secondary education prior to acupuncture school in statute—such as an associate’s or bachelor’s degree—are few and far between.

The majority of states simply require that acupuncturists graduate from a “board-approved school,” a “nationally accredited school,” or, most specifically, an “ACAHM-approved or accredited school.” This means they leave it to the schools to set the prerequisite education standards for their applicants.

Some state laws still refer to “ACAOM-approved or accredited schools.” Those states need to update their language to reflect the organizational name change that happened quite a while ago.

The states that require an associate’s degree or 60 credit hours are Arkansas, California, Connecticut, Massachusetts, and New York. Arkansas and Massachusetts specifically require 30 hours of biomedicine credits. New York requires a minimum of nine hours of biomedicine credits.

The states that require baccalaureate degrees are Maine, New Hampshire, and New Jersey. Out of these three, New Jersey is the only one that has an acupuncture school. States with acupuncture schools generally have more acupuncturists than those without. The baccalaureate requirement is arguably bad policy for any state, but especially for those without schools. It severely limits patient access to acupuncture and limits who can become an acupuncturist and where they can live and work after graduation.

Thankfully, acupuncturists in New Hampshire, where I live, are currently working to remove the baccalaureate requirement in favor of offering licensing to applicants who have graduated from an ACAHM-approved school. Thank you to the New Hampshire Acupuncture and Asian Medicine Association (NHAAMA) for working on this language change.

Arkansas surprised me—not only with its associate’s degree and biomedicine requirements. Licensees in “The Natural State” are required to graduate from a four-year acupuncture school and pass the herbal certification exam along with the other NCBAHM/NCCAOM exams (though active NCBAHM/NCCAOM status is not required). Arkansas, like Maine and New Hampshire, does not have any accredited acupuncture colleges. This is likely why they only have 38 active licenses in the entire state as of 2025.

Nevada technically requires a baccalaureate degree, but it will accept a combined bachelor’s/master’s degree from an accredited acupuncture school to fulfill that requirement. However, Nevada also requires that licensees graduate from a four-year acupuncture school.

Active Status with the NCBAHM (formerly NCCAOM)

Most states require a passing score on the NCCAOM/NCBAM tests. However, only ten states require active status (recertification) with the NCBAHM: Florida, Illinois, Kansas, Indiana, Iowa, Louisiana, Minnesota, Ohio, South Carolina, and Virginia.

If you think that keeping active status with NCCAOM/NCBAHM makes it easier to transfer your license to another state, that is not necessary true. Every state sets their own requirements. 

Now that the NCBAHM has updated its name, perhaps it will finally update its map of the states that require its exams. While most states only accept NCBAHM exams, several state practice acts use language that does not specify the NCCAOM/NCBAHM directly. Examples include “board-approved nationally recognized exam,” “exam approved by the licensing director,” or “NCBAHM or proof of substantially similar certification.”

Colorado accepts the California Acupuncture Licensing Exam (CALE) as an equivalent to the NCBAHM exam. I am happy to know an acupuncturist who was instrumental in working with state lawmakers in Colorado to make that happen. While the Colorado Practice Act does not specifically mention the CALE, I found additional legal language for Colorado’s acupuncture law on a website connected to Cornell Law School.

In 2022, New Hampshire adopted the language “NCCAOM or equivalent.” The NCCAOM has not updated its map to reflect the changes for New Hampshire or Colorado. I reached out to the NCBAHM more than once asking them to update their information, as did a colleague in state association leadership. It is not a good look when one of the largest acupuncture organizations in the country shares information that is no longer accurate.

Length of Preliminary Acupuncture Training

The minimum requirement for acupuncture training varies widely by state.

Some states do not specify a required a set number of credit hours for the length of an acupuncture program; they only require that the school be ACAHM/ACAOM approved or accredited, or a program approved by the state. Those states are Alaska, Kansas, Colorado, North Dakota, Oregon, Pennsylvania, Vermont, Virginia, and Wyoming.

Montana requires the fewest hours (1,000), while New York requires the most (4,050).

Another group of states requires licensees to prove three years of acupuncture education: DC, Indiana, Iowa, North Carolina, and Tennessee. Louisiana requires 36 months of training. Arkansas, Nevada, and Florida require four years of acupuncture education, while Wisconsin and Washington require two years.

Herbal Requirements

Many of us are familiar with the states that require acupuncturists to be trained in herbs: Arkansas, California, Florida, New Mexico, and Texas.

New Jersey requires that herbalists maintain active NCBAHM certification in herbs. The NCCAOM/NCBAHM states that Massachusetts acupuncturists who practice herbs must also be certified. However, I found conflicting information via Cornell Law School stating that in Massachusetts, acupuncturists who practice herbs may either keep active NCBAHM status or simply take 10 CEUs specific to herbal practice each renewal cycle.

CEU Requirements

CEU requirements vary widely. Colorado and Wisconsin do not require CEUs for license renewal. Alaska requires a minimum of 15 CEU hours every two years, while Nebraska requires 50 hours every two years. The rest of the states fall somewhere in between.

Apprenticeship

Three state laws offer pathways to licensure via apprenticeship: DC, Idaho, and New Hampshire. I believe the NCCAOM/NCBAHM will not allow acupuncture apprentices to sit for its exams. Please leave a comment below if you have different information.

States That Do Not Regulate Acupuncture

Alabama, Oklahoma, and South Dakota are the three states that do not regulate the practice of acupuncture for acupuncturists, but the situation looks different in each state.

In Alabama, MDs and DOs can practice acupuncture, while physical therapists and chiropractors can practice dry needling. It does not appear that an acupuncturist can “set up shop” in Alabama; they would essentially be practicing without a state license.

Oklahoma, on the other hand, has a state association that holds annual symposiums and offers CEUs approved by the NCCAOM/NCBAHM. Membership includes acupuncturists and Auricular Acupuncture Technicians (AATs), also known as Acupuncture Detoxification Specialists (ADS) or 5NP Technicians. In states that regulate AAT/ADSes, these technicians only practice the 5-needle protocol on the ear (AcuDetox/NADA/5NP). However, in Oklahoma, I imagine that this group of practitioners is free to take additional training in auriculotherapy, like in the state of Vermont. 

Another group of Oklahoma acupuncturists has been pushing for a practice act against the wishes of the original state association. In 2019, there was an attempted “hostile takeover” of the association; you can read more about that ordeal on the Oklahoma association’s website.

Take Aways

Putting this together made me realize how much our ‘zip code’ determines our professional destiny. It’s wild that an hour’s drive across a state line can be the difference between needing a bachelor’s degree or just a diploma from an approved school.

As community acupuncturists, we’re often the ones trying to make this medicine accessible, but sometimes the laws themselves are the biggest gatekeepers. Which of these state requirements do you think are actually protecting the public, and which ones are just making it harder for us to serve our communities? I’m curious to hear your take.

 

Elizabeth Ropp (Roppy)is a practicing “acu-punk” at Manchester Acupuncture Studio in Manchester, NH, since 2010. She has worked closely with lawmakers in the Granite State to modernize the New Hampshire Acupuncture Practice Act. Her efforts were instrumental in the legal recognition of Acupuncture Detoxification Specialists (ADS), a project for which she earned an award from the National Acupuncture Detoxification Association (NADA). Her additional legislative wins include establishing term limits for the state licensing board and removing the requirement for active NCCAOM status for licensure renewal. In 2018, she was elected to serve as Hillsborough County’s Register of Probate—hence the “Honorable” title.